Benign Essential Tremor
(Essential Tremor; Familial Tremor)
DefinitionBenign essential tremor (ET) is a movement disorder most commonly noticed by shaking in the hands. It occurs in about 5% of older adults. It may also cause shaking of the head, voice, arms, and trunk. It occurs less often in the legs and feet. Two types of tremor are common with ET:
- Postural tremor—shaking in certain positions only, such as with arms outstretched
- Kinetic or action tremor—shaking that gets worse during activities, such as eating or shaving
CausesFor some people, ET is caused by a genetic mutation. For others, the cause is not clear.
Risk FactorsFamily history of tremors is the only known risk factor for ET. The condition may occur at any age. It is more likely to occur in teens and people older than 50 years old.
SymptomsET is generally not serious, but its severity may vary and worsen over time. Symptoms may include:
- Tremor that occurs when standing or moving the limbs, but not usually at rest
- Uncontrollable, rhythmic movement
- Shaking most common in hands, arms, head, or voice
- Shaking only in certain positions or during activity
- Trouble with fine motor skills such as drawing, sewing, or playing an instrument
- Shaking that gets worse from caffeine, stress, fatigue, or heat
- Shaking that may decrease when using alcohol
- Hearing loss
- Problems with social, functional, or job-related abilities in more severe cases
DiagnosisYou will be asked about your symptoms and your medical and family history. A physical exam will be done. Attention will be paid to the central nervous system. There are no special tests to diagnose ET.
TreatmentMost people with ET do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:
- Staying well-rested
- Avoiding caffeine
- Avoiding stimulants often found in over-the-counter medications, like cold remedies
- Avoiding temperature extremes
MedicationMedications may include:
- Botulinum injections
SurgerySurgery may be an option in rare cases where tremors are disabling and medications don’t help. Two approaches are possible.
- Deep brain stimulation (DBS)—sends painless electrical pulses to the brain, interrupting faulty signals
- Thalamotomy—destroys a tiny part of the brain (less commonly performed than DBS)
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