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Benign Essential Tremor
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Benign Essential Tremor

(Essential Tremor; Familial Tremor)

En Español (Spanish Version)

Definition

Benign essential tremor (ET) is a movement disorder most commonly characterized by shaking in the hands. It may also cause shaking of the head, voice, arms, and trunk, and less often, of 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

In some cases, ET can be socially isolating. It may interfere with normal daily activities such as writing or speaking. If so, contact your doctor for an evaluation.

Causes

The cause of ET is unknown. However, it does run in families. When inherited, it is often called familial tremor. Children of parents with ET have a 50% chance of inheriting the condition.

In cases where there is no family history of tremor, other factors such as toxins may play a role, though this is far from clear. It is thought that essential tremor arises from abnormalities of specific circuits in the brain. This is actively being investigated by researchers.

The Nervous System

Nervous system posterior 3D

Benign essential tremor occur when faulty nerve cells (or circuits) in the brain send abnormal signals to muscles.

© 2008 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Family history of tremors is the only known risk factor for ET. Although the condition may occur at any age, it is more likely to occur in people older than 40 years old.

Symptoms

ET is generally not serious, but its severity may vary and worsen over time. Symptoms of ET may include:

  • Uncontrollable, rhythmic, up-and-down movement
  • Shaking in hands, arms, head, voice, trunk, legs, or feet on both sides
  • 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

To be considered as having ET, tremors must not be related to other health conditions.

Diagnosis

Your doctor will ask about your symptoms and your medical and family history, and perform a physical exam, paying particular attention to your neurologic system. At this time, there are no special tests used to diagnose ET. But you may have blood, urine, or other tests such as an MRI to rule out other causes of tremulousness, such as:

Treatment

Most 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

Talk to your doctor about any medications that may be contributing to your symptoms. If your symptoms are troubling, the following treatment options may be helpful:

Medication

  • Beta-blocker (propranolol), a blood pressure medication
  • Anti-seizure medications (primidone, gabapentin, topiramate)
  • Sedatives (benzodiazepines)
  • Botulinum injections (Botox) is used in rare situations

Surgery

In rare cases where tremors are very disabling and medications don’t help, surgery may be an option. Two approaches are possible.

  • Deep brain stimulation (DBS)—transmits painless electrical pulses to the brain, interrupting faulty signals.
  • Thalamotomy—destroys a tiny part of the brain generating the tremors. This is less commonly performed than DBS.

Prevention

There is no known way to prevent ET.

RESOURCES:

International Essential Tremor Foundation (IETF)
http://essentialtremor.org

WE MOVE (Worldwide Education and Awareness for Movement Disorders)
http://www.wemove.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org

Parkinson Society Canada
http://www.parkinson.ca

References:

Essential tremor. American Academy of Family Physicians website. Available at: http://familydoctor.org/807.xml?printxml . Accessed August 4, 2005.

Essential tremor. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00367 . Accessed August 4, 2005.

Introductory packet. International Essential Tremor Foundation website. Available at: http://essentialtremor.org/ . Accessed August 4, 2005.

Jacques D, Young R, Essential tremor. International Radiosurgery Support Association website. Available at: http://www.irsa.org/essential_tremor.html . Accessed August 4, 2005.

Lorenz D, Deuschl G. Update on pathogenesis and treatment of essential tremor. Current Opinions in Neurology . 2007;20:447-452.

What is essential tremor? Who gets ET? International Essential Tremor Foundation website. Available at: http://essentialtremor.org/about_us/about_essential_tremor.php . Accessed August 4, 2005.



Last reviewed January 2008 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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