Definition
Essential tremor is a nerve disorder in which tremors (shakes) occur in a person who is moving or trying to move and no cause can be identified.
Symptoms
The tremors:
- May be occasional (sporadic), temporary (episodic) or occurring at intervals (intermittent)
- Occur at a rate of about 6 to 10 oscillations per second
- May affect the head, hands, arms, eyelids, voice
- Less commonly affect the legs and feet
- May not affect both sides of the body equally
- Worsen with voluntary movement or emotional stress
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Definition
Essential tremor is a nerve disorder in which tremors (shakes) occur in a person who is moving or trying to move and no cause can be identified.
Symptoms
The tremors:
- May be occasional (sporadic), temporary (episodic) or occurring at intervals (intermittent)
- Occur at a rate of about 6 to 10 oscillations per second
- May affect the head, hands, arms, eyelids, voice
- Less commonly affect the legs and feet
- May not affect both sides of the body equally
- Worsen with voluntary movement or emotional stress
- Disappear during sleep
- Typically improve with alcohol
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Causes
All people have some degree of tremor during movement. This shaking normally involves mainly the hands. Stress, fatigue, anger, fear, caffeine, and cigarettes may temporarily worsen this type of tremor.
Essential tremor is the most common form of abnormal tremor. Although the cause is unknown, new research shows that the part of the brain called the cerebellum does not appear to work correctly in patients with essential tremor. The cerebellum is the part of the brain that coordinates muscle movements.
Essential tremor is a relatively benign condition, affecting movement or voice quality, but with no other effects. It involves a rhythmic, moderately rapid tremor of voluntary muscles. Purposeful movements may make the tremors worse, while avoiding hand movements may make the tremors go away completely. People with essential tremors may ...
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Treatment
Treatment may not be necessary unless the tremors interfere with the ability to perform daily activities or if they are considered embarrassing to the patient.
Medications help relieve symptoms in most patients. Two medications are considered the first line of therapy: propranolol and primidone. Propranolol blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline. Primidone is an anti-seizure medication, which also control the function of some neurotransmitters. The drugs can have significant side effects.
Side effects of propranolol include:
- Fatigue
- Shortness of breath (people with asthma should not use this drug)
- Slowing of the heart rhythm
- Nose stuffiness
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Possible Complications
If it is severe, essential tremor can mildly interfere with activities, especially fine motor skills such as writing. Speech is occasionally involved. Medications can cause side effects.
Outlook (Prognosis)
An essential tremor is not a dangerous condition, but it may be annoying and embarrassing.
Prevention
Techniques to reduce emotional stress, such as counseling and exercise, may help. Stress can make essential tremors worse.
Exams and Tests
There is no laboratory test to diagnose essential tremor. The diagnosis is based on the patient's history, a physical examination revealing tremor on voluntary movement, and no other abnormalities.
However, some testing may be done to rule out other causes of tremors, such as excessive caffeine or tobacco use, alcohol withdrawal , use of certain medications (for example, asthma drugs, lithium, certain antidepressants and anti-seizure drugs), hyperthyroidism , pheochromocytoma , and Wilson's disease.
Routine laboratory tests and brain imaging studies (such as CT scan of the head, brain MRI , and x-rays), or other tests are usually normal.
