What Is Essential Tremor?

The condition that affects as many as 10 million Americans can sometimes be mistaken for Parkinson’s disease

Margie Zable Fisher,

AARP

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En español

Published October 07, 2024

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As long as I can remember, my aunt’s head would shake from side to side, as if she was disagreeing with those around her. But my family never talked about it.

Fast-forward to my 30s when I was meeting with a business client. He was unhappy with something, and said to me, “Look, you’re so nervous, you’re shaking.”

I wasn’t nervous, but my hands were trembling — a symptom I later learned my husband had noticed but never brought up. I called my mom for a consult. “I guess you have the family tremors,” she told me.

We all have tremors when we move our hands, and these slight shakes can become more obvious if you’ve had a lot of caffeine, or if you’re stressed or angry. But if you have noticeable tremors all or most of the time, you may be like me, one of the roughly 7 to 10 million Americans with essential tremor, a movement disorder that causes involuntary rhythmic shaking of the hands, arms and sometimes other body parts during activity.

Unlike many health conditions, it’s not dangerous, but it can be disruptive, especially if it worsens over time.

What causes essential tremor?

It’s still unclear what, exactly, causes essential tremor, though researchers are starting to shore up some answers. That’s because the disorder wasn’t studied comprehensively until recently, says Elan D. Louis, M.D., chair of the department of neurology at the University of Texas Southwestern Medical Center.

In 2003, Louis and a team of researchers established a brain bank at Columbia University in New York to examine postmortem brains of those affected by essential tremor. They’ve discovered that changes in the part of the brain that’s responsible for motor movement and balance may play an important role in the development of the disorder.

There’s also a genetic component. “Essential tremor is highly, highly heritable,” says Debra J. Ehrlich, M.D., director of the Parkinson’s Disease Clinic at the National Institute of Neurological Disorders and Stroke. In fact, about half of all essential tremor cases are inherited, according to Mayo Clinic; however, the genetic mutations and variants responsible are still unknown, Ehrlich says.

Several family members on my father’s side have essential tremor, including my aunt and cousin, so I am part of the majority.

Tremors usually begin in adolescence (between ages 10 and 19) or middle age (between 40 and 50), according to the National Institute of Neurological Disorders and Stroke, but can appear at any time. According to Johns Hopkins Medicine, essential tremor is most common in people older than 65.

Is it essential tremor?

If you notice a tremor, your mind might jump straight to Parkinson’s disease, as tremors are a well-known symptom of the disease. But with Parkinson’s, tremors usually occur at rest, whereas tremors during activity are typically a symptom of essential tremor, Ehrlich says.

6 Symptoms of essential tremor

Someone with essential tremor might experience:

Tremors that occur during activity and are less noticeable at rest
Worsening tremors with caffeine, stress or certain medications
Difficulty doing tasks with your hands (writing, using utensils)
A shaking or quivering sound in your voice
Uncontrollable head nodding
Tremors that get worse with age

Source: Johns Hopkins Medicine

There are exceptions to the “rest” versus “active” rule , Louis cautions, so if you have a tremor that concerns you, make an appointment with a movement disorder neurologist for a diagnosis.

Unfortunately, there is no test to diagnose essential tremor. A diagnosis is based on a neurological exam, which generally includes getting a medical history, as well as a history of the symptoms and experiences of the patient, Ehrlich says.

Treating essential tremor

There are medications that can help treat tremors, and many are covered by private insurance plans and Medicare. Among the more common medications that are effective at treating tremors in the hands and arms are primidone (an anti-seizure medication) and propranolol (a beta-blocker). Just be sure to discuss potential side effects with your doctor, as these medications can lower your blood pressure, affect your heart rate and more.

Another possible course of treatment, especially if you have hand and head tremors: botulinum toxin injections (Botox), which acts by weakening the muscles.

In the case of essential tremor, certain muscles are overactive, explains Philip W. Tipton, M.D., a neurologist and assistant professor and senior associate consultant in the Department of Neurology at Mayo Clinic in Jacksonville, Florida. So weakening those muscles can significantly reduce the tremor.

If medications and/or botulinum injections don’t work, surgery is another option for some, including:

Deep brain stimulation (DBS): During this procedure, a surgeon inserts small electrodes in your brain to fix impaired brain signals that cause tremors. The electrodes have a wire attached to an implantable pulse generator — a device implanted just below the collarbone that acts as a battery and computer telling the electrode how to behave. Side effects such as slurred speech and tingling sensations are possible, but this treatment has a high success rate, Tipton says: “I tell my patients we expect about 80 percent of improvement in about 80 percent of patients.”
High-Intensity focused ultrasound: High-intensity sound waves heat up a small area of your brain to block the signals that cause tremor, Ehrlich explains. The success rate for this type of surgery is also high. One study showed that hand tremors were reduced by 73 percent in patients four and five years after having this surgery. Potential side effects include balance issues, nausea, headaches, numbness, and swallowing and speech problems.

Newest to the menu of treatment options is a wrist device that’s federally approved to treat hand tremors. Available by prescription, “it kind of looks a little bit like a smartwatch,” Ehrlich says, and delivers a certain pattern of electrical stimulation to the nerves that disrupt the tremor. One study published in 2020 showed an improvement in tremors in people wearing the device, but Louis cautions that additional testing is needed to determine how well it will help patients.

Beyond medications, surgeries and other therapies, a few other modifications can help people with essential tremor:

Use two hands. This may help when you’re drinking a glass of water or carrying a dish to the table. Ehrlich tested this out with a group of her patients and found that tremor severity lessened when both hands were doing an activity together.
Do muscle-strengthening exercises. Some studies have shown that upper-limb resistance training may reduce tremors in older patients.
Check your meds. Some medications can worsen essential tremor, so ask your doctor to do a medication review at your next appointment.
Try weighted products. Everything from weighted silverware for eating to weighted pens for writing can help some people reduce tremors and make everyday tasks easier to perform. You can also try food guards (to help keep your food from falling off your plate) and cups with lids to minimize spills.

Looking forward

The vast majority of people with essential tremor experience worsening symptoms over time, Louis says — typically by about 2 to 5 percent per year. This progression could include more tremors or stronger tremors, he says, along with unsteadiness of gait and dystonia, where the muscles contract, causing the body to make involuntary twisting and other types of movements.

My tremors have gotten slowly worse with time and have progressed to my head. The medications weren’t good options for me. But while the shaking can be embarrassing, it doesn’t affect my life too much.

However, I might consider some other treatment options, such as Botox for my head and the wrist device. Next year, my first novel is coming out, and I want to be able to sign my books and speak at events without shaking.

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