Essential tremor is a neurological disorder that causes involuntary shaking in the body. The shaking (tremors) can range from mild to severe, potentially affecting a person's ability to perform daily activities.
The specific cause of essential tremor is not known. It can appear at any age but is mainly found in people over age 65.
Potential treatments for essential tremor include medication, deep brain stimulation, focused ultrasound, and Gamma Knife® radiosurgery.
Doctors define essential tremor as a neurological disorder that causes involuntary shaking in one or more areas of the body. More specifically, essential tremor is a movement disorder, meaning it affects parts of the brain that control body movement or motor function.
Tremors are very rapid, generally more than five times a second. The shaking can occur in the hands, arms, head, voice, or other muscles. It rarely occurs in the lower extremities. The tremor may be mild initially but can worsen over time.
In some cases, the tremor may be severe enough to interfere with:
Essential tremor is not dangerous or life-threatening, but many people find it annoying and embarrassing.
The cause of essential tremor is unknown.
Research shows a link between essential tremor and degeneration of the cerebellum, an area of the brain in the back of the head. The cerebellum has several functions, including controlling voluntary muscle movements.
Essential tremor is often inherited. An inherited case of essential tremor is known as familial tremor.
Because many cases of essential tremor are inherited, genetics may be one factor in how the condition develops. However, essential tremor can also occur in people with no family history.
Essential tremor can occur at any age, including during childhood. But it is more common in older adults and tends to become more pronounced with age.
Your risk of essential tremor can be higher based on:
Researchers have also focused on other risk factors, including sex, race, ethnicity, and lifestyle factors. To date, nothing is conclusive.
Essential tremor is not life-threatening, but the tremors can cause problems with daily activities. For example, you may have trouble holding a pencil or pen and writing your name. Your voice may be shaky when you speak. Or you may find eating and drinking difficult.
The symptoms of essential tremor may worsen over time and cause an even greater impact on your daily life.
Essential tremor is the most common type of tremor, affecting about 7 million people in the U.S.
The involuntary shaking of essential tremor generally involves small, rapid motions that occur more than five times per second.
The tremor is typically more noticeable when people perform actions like writing, eating, or drinking, and is less noticeable when people are at rest. Triggers like caffeine, stress, or fatigue can make tremors worse.
Essential tremor is most commonly noticed in the hands, but it may also affect your:
Essential tremor in the legs and feet is very rare. The tremors may also not affect both sides of your body in the same way.
Emotional and behavioral impacts are possible because of essential tremor. Your symptoms may cause you to feel anxious, frustrated, angry, and more.
Many people experience tremors at various times, but you should see a doctor if:
Contact your primary care provider (PCP), who can refer you to a neurologist for evaluation and diagnosis.
If you have symptoms of essential tremor, neurologists can evaluate your symptoms and provide a diagnosis.
To diagnose essential tremor, your doctor will ask for your medical history. They also will perform a physical exam, looking for specific essential tremor symptoms.
These symptoms may include:
They may ask you to perform tasks like holding your arms in front of you, writing your name, or drawing a spiral.
There are no medical tests beyond a physical or neurological exam to diagnose essential tremor. In general, essential tremor does not affect coordination or mental function. Blood tests and imaging studies, such as MRI and CT scans, usually show no problems.
Based on your medical history, your doctor may order tests to rule out other conditions that could be causing your tremors. These tests could include thyroid testing, kidney and liver function tests, or screenings for toxins.
Essential tremor is not life-threatening and the severity depends on the person. Some people experience only mild tremors while others have tremors that worsen as they age. In some cases, tremors can affect your ability to perform daily tasks or may be annoying or frustrating.
If you have mild symptoms, you may not need or want treatment. However, nonsurgical and surgical treatments are available.
Although there is no cure for essential tremor, treatment can help relieve symptoms and improve your quality of life.
Treatment options depend on:
You may not need essential tremor treatment unless your tremors and their symptoms interfere with your daily life or cause embarrassment.
Experts at UPMC offer many state-of-the-art treatments to alleviate the symptoms of movement disorders and allow people to lead fuller and more independent lives.
Avoiding triggers such as fatigue, caffeine, or stress may help you control your symptoms. Avoid foods and drinks with caffeine, get enough rest, and talk to your doctor about stress-management techniques.
If your symptoms are making it hard to perform daily activities, occupational and/or physical therapy may help. You also could consider adaptive devices like weighted utensils, wrist weights, and Velcro™️clothes fasteners.
Medications commonly used to alleviate essential tremors include:
Your doctors will work closely with you to monitor your response to medication and any side effects.
If a medication is triggering your symptoms, talk to your doctor about changing your dosage or switching to a new medication.
UPMC is a leader in treating movement disorders such as essential tremor with deep brain stimulation (DBS). We offer both standard and MRI-guided asleep DBS, depending on your condition.
Deep brain stimulation delivers electrical stimulation to targeted areas in the brain that control movement. This stimulation blocks the brain signals that cause abnormal movement.
DBS provides significant benefits in 80% to 90% of people who undergo the procedure for essential tremor.
DBS is a surgical procedure that lasts several hours and requires a short hospital stay.
It involves the following:
Focused ultrasound is a nonsurgical, noninvasive procedure for essential tremor that combines ultrasound and MRI technology. About 30 to 40 high-intensity, targeted ultrasound beams ablate (burn) the area of your brain that is causing abnormal movement. The ablation creates a permanent lesion and helps to improve your symptoms.
You can have focused ultrasound performed on one or both sides of your brain. People who undergo focused ultrasound may notice improvements in their symptoms during the procedure. It may help improve symptoms by up to 80%, but it is not a permanent solution.
Focused ultrasound involves:
A focused ultrasound procedure lasts one to two hours, and you can go home the same day. People typically experience an improvement in their symptoms during the procedure and afterward.
However, focused ultrasound is not a cure for essential tremor. Your symptoms may return years later.
Gamma Knife radiosurgery is a painless procedure that, despite its name, requires no surgical incision.
In Gamma Knife, hundreds of highly focused radiation beams target deep brain regions to create precise functional lesions within the brain. Gamma Knife may be a treatment option for people with essential tremor who are at high-risk for surgery due to medical conditions or advanced age.
Gamma Knife radiosurgery involves:
Gamma Knife radiosurgery can last anywhere from 20 minutes to several hours. You may be able to go home the same day.
Whether you get treatment for essential tremor depends on the severity of your symptoms and the challenges they cause. If your symptoms are severe and are causing you difficulty in your daily life, talk to your doctor about treatment.
The first-line treatment for essential tremor is medication. You may try more than one medication before finding one that helps control your symptoms.
If your symptoms have not improved after trying multiple medications, talk to your neurologist about deep brain stimulation, focused ultrasound, or Gamma Knife radiosurgery.
While treatments may help to control your symptoms, there is no cure for essential tremor.
Recovery time can vary after deep brain stimulation, focused ultrasound, or Gamma Knife radiosurgery for essential tremor. Deep brain stimulation typically will require a short hospital stay. Focused ultrasound and Gamma Knife may allow you to go home the same day.
In most cases, you can return to your normal routine within a few days of undergoing essential tremor treatment.
At UPMC, we are a national leader in diagnosing and treating movement disorders such as essential tremor. We can help you manage and treat your condition, improving your quality of life.
With UPMC, you can expect:
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