August 4, 2021

The most common trembling disorder? It’s not what you think

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Often mistaken for Parkinson’s disease, essential tremor can affect people at any age.

It’s a condition that’s often mistaken for Parkinson’s disease and is the most common of the trembling disorders. Essential tremor, or commonly referred to as ET, is a neurological disorder that causes your hands, head, trunk, or voice to shake rhythmically. Though it is most common among people older than age 65, it can affect people at any age.

“Movement disorders are complex. Because tremors can be a symptom of other neurological disorders, a specialist’s careful assessment is extremely important in diagnosing ET,” said Dr. Britt Stone, a neurologist with the Vanderbilt Movement Disorders program.

What causes essential tremor?

Essential tremor can occur in different people for different reasons. In most people, the condition seems to be passed down from a parent to a child. If your parent has ET, there is a one in two chance that you or your children will inherit the gene responsible for the condition. 

But the cause of ET isn’t known. One theory suggests that the cerebellum, which controls muscle coordination, and other parts of the brain are not communicating the right way.

What are the symptoms for essential tremor?

If you have ET, you will have shaking and trembling at different times and in different situations. But some characteristics are common to all. Here is what you might typically experience:

  • Tremors occur when you move and are less noticeable when you rest.
  • Certain medicines, caffeine or stress can make your tremors worse.
  • Tremors may improve with ingestion of a small amount of alcohol (such as wine).
  • Tremors worsen as you age.
  • Tremors don’t affect both sides of your body in the same way.

Here are different signs of ET:

  • Tremors that are most obvious in your hands
  • Having a hard time doing tasks with your hands, such as writing or using tools 
  • A shaking or quivering sound in your voice
  • Uncontrollable head-nodding

How is essential tremor diagnosed?

Your rapid, uncontrollable trembling, as well as questions about your medical and family history, can help your specialist determine if you have ET. Your doctor will probably need to rule out other conditions that could cause shaking or trembling. For example, tremors could be symptoms of diseases, such as hyperthyroidism, so you might be tested for those. 

In some cases, the tremors might be related to other factors. To find out for certain, you may be asked to: 

  • Abstain from heavy alcohol use (if you’re an alcoholic, trembling is a common symptom). 
  • Cut out cigarette smoking.
  • Stay away from caffeine.
  • Stop taking certain medicines.

How is ET treated? 

Propranolol and primidone are two medicines often prescribed to treat ET. Propranolol blocks the stimulating action of neurotransmitters to calm your trembling. Primidone is a common antiseizure medicine that also controls the actions of neurotransmitters. 

Gabapentin and topiramate are two other antiseizure medicines that are sometimes prescribed. In some cases, tranquilizers like alprazolam or clonazepam might be suggested. 

For ET in your hands or neck, botulinum toxin (Botox) injections have shown some promise in easing the trembling. They work by weakening the surrounding muscles around your hands. For severe tremors, a stimulating device (deep brain stimulator) surgically put in your brain may help.

What can I do to help prevent ET? 

The specific cause of ET is not known, so scientists are not sure how the condition can be prevented. 

Living with ET

ET is usually not dangerous. But it can certainly be frustrating and affect the quality of your life. Certain factors can make tremors worse. The following steps may help to decrease tremors: 

  • Don’t smoke.
  • Stay away from caffeine.
  • Limit alcohol. Small amounts of alcohol may improve the symptoms of ET, but the risk for alcoholism is a concern when people rely on it. 
  • Stay away from stressful situations as much as possible. 
  • Use relaxation techniques, such as yoga, deep-breathing exercises or biofeedback. 
  • Check with your healthcare provider to see if any medicines you’re taking could be making your tremors worse. 

Talk with your specialist about other options, such as focused ultrasound or surgery, if ET starts to affect your quality of life. 

When should I call for help?

If you have been diagnosed with essential tremor, talk with your doctor about when you might need to call. That advice will likely be if your tremors become worse, or if you develop new neurologic symptoms, such as numbness or weakness.

How should I prepare for my medical appointments?

Tips to help you get the most from a visit to your specialist:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your doctor tells you. 
  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you. 
  • Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are. 
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time and purpose for that visit. 
  • Know how you can contact your health-care team if you have questions.
Parkinson’s disease

Vanderbilt’s Movement Disorders Clinic provides advanced care to those experiencing involuntary and excess movement, impaired balance and coordination, muscle rigidity, slow movement or other symptoms. The clinic specializes in treating Parkinson’s disease, dystonia, tremors and spasticity resulting from stroke, multiple sclerosis and head injuries. Schedule your appointment online or call 615-678-0480.

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