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Essential tremor is a type of involuntary shaking movement in which no cause can be identified. Involuntary means you shake without trying to do so.
Tremor - essential; Familial tremor; Tremor - familial
Essential tremor is the most common type of tremor. Everyone has some tremor present, but the movements are often so small that they cannot be seen. Essential tremor affects men and women and is most common in people older than 65.
The exact cause of essential tremor is unknown. Some research suggests that the part of the brain that controls muscle movements does not work correctly in patients with essential tremor.
If an essential tremor occurs in more than one member of a family, it is called a familial tremor. This type of essential tremor is passed down through families (inherited). This suggests that genes play a role in its cause.
Familial tremor is usually a dominant trait. This means that you only need to get the gene from one parent to develop the tremor. It often starts in early middle age, but may be seen in people who are older or younger.
The tremor is more likely to be noticed in the hands. The arms, head, eyelids, or other muscles may also be affected. The tremor rarely occurs in the legs or feet. A person with essential tremor may have trouble holding or using small objects such as silverware or a pen.
The shaking most often involves small, rapid movements occurring more than 5 times a second.
Specific symptoms may include:
The tremors may:
Your doctor can make the diagnosis by performing a physical exam and asking questions about your medical and personal history.
A physical exam will show shaking with movement, usually small movements that are faster than 5 times per second. There are usually no problems with coordination or mental function.
Further tests may be needed to rule out other reasons for the tremors. Other causes of tremors may include:
Blood tests and imaging studies (such as a CT scan of the head, brain MRI, and x-rays) are usually normal.
Treatment may not be needed unless the tremors interfere with your daily activities or cause embarrassment.
For tremors made worse by stress, try techniques that help you relax. For tremors of any cause, avoid caffeine and get enough sleep.
For tremors caused or made worse by a medication, talk to your doctor about stopping the drug, reducing the dosage, or switching. Do not change or stop medications on your own.
Severe tremors make it harder to do daily activities. You may need help with these activities. Things that can help include:
MEDICINES FOR TREMOR
Medicines may help relieve symptoms. The most commonly used drugs include:
These drugs can have side effects.
Other medications that may reduce tremors include:
Botox injections given in the hand may be tried to reduce tremors.
In severe cases, surgery may be tried. This may include:
An essential tremor is not a dangerous problem. But some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, writing, eating, or drinking.
Sometimes the tremors affect the vocal cords, which may lead to speech problems.
Call your health care provider if:
Alcoholic beverages in small quantities may decrease tremors. But alcohol abuse may develop, especially if you have a family history of such problems.
Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011;10:148-161.
Jankovic J. Movement disorers. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.