Essential tremor
Essential tremor (ET) is a neurological disorder that causes your limbs to shake rhythmically. It is a progressive disorder involving uncontrolled tremors in different parts of the body, most often in the hands.
Essential tremor can vary over time
Tremors can vary from mild to significant over time, but essential tremor is not disabling for most people. There are treatments to help with the frequency and strength of the tremors.
What does it mean if you have shaky hands?
Essential tremor is the most common form of shaky hands. A person experiencing trembling in their hands needs to note when their hands tremor, for example, after too much caffeine, too much stress, after taking a certain medication, or while the hands are moving or at rest.
Causes of essential tremor
Genetic causes
For more than half of the population with essential tremor, the cause is hereditary and genetic in nature. Because of this, essential tremors are also referred to as “familial tremors.”
Those with a family member with a genetic marker for essential tremor have a 50 percent chance of developing the tremor themselves.
Other causes
The other half of cases are unknown in cause.
Anxiety and stress can increase the frequency of essential tremors, but are not the root cause.
Tremors caused primarily by anxiety or stress are called “psychogenic tremors.”
The effects of certain medications
Drugs that can cause or worsen tremor include:
- Antidepressant drugs, such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclics.
- Asthma medicines such as Theophylline and Albuterol.
- Cancer medicines such as Thalidomide and Cytarabine.
- Certain antibiotics.
- Certain antivirals, such as Acyclovir and Vidarabine.
- Epinephrine and Norepinephrine.
- Heart medicines such as Amiodarone, Procainamide, and others.
- High blood pressure drugs.
- Immune suppressing medicines such as Cyclosporine and Tacrolimus.
- Mood stabilizers, such as lithium carbonate.
- Nicotine.
- Tetrabenazine, a medicine to treat excessive movement disorder.
- Too much alcohol.
- Too much thyroid medicine (e.g. Levothyroxine).
- Seizure medicines such as valproic acid (Depakote) and sodium valproate (Depakene).
- Stimulants such as caffeine and amphetamines.
- Weight loss medicine (e.g. Tiratricol).
Symptoms of essential tremor
The most common symptom of essential tremor is rhythmic trembling which most often develops in the hands first. This can cause difficulty doing small tasks like writing, holding a cup, and using utensils.
What sets essential tremor apart from other tremor-causing disorders is that essential tremors usually occur more prominently on one side of the body and are more likely to tremor when you move, and less when you rest. They also worsen with caffeine, stress, fatigue, temperature changes, and age.
Essential tremor is more common in people 40 years and older, but can occur in younger people due to genetics.
Diagnosing essential tremors
Essential tremors are diagnosed only after ruling out other conditions that can also cause tremors such as medication side effects, metabolic problems, thyroid disease, and most commonly, Parkinson’s disease.
Doctors can most commonly narrow down the cause of the tremors through a physical and neurological examination, noting the location and frequency of the tremors, reviewing medical history, family history, and with a blood and urine analysis.
Should the doctor still be unsure if it is an essential tremor or Parkinson’s disease, a dopamine transporter scan may be ordered. The dopamine scan is FDA approved to help differentiate Parkinson’s disease from an essential tremor.
Treatments for essential tremor
Essential tremors can be mild enough that no treatment is necessary. However, if the essential tremor is getting so that everyday activities are becoming difficult, your doctor might suggest physical or occupational therapy, medications, or surgery depending on the severity of the tremor.
Physical or occupational therapy
Physical therapy and occupational therapy are one way an essential tremor can be improved. Physical therapists can provide specific muscle exercises that can help with control, coordination and muscle strength.
An occupational therapist can help you work through your essential tremor in everyday activities with the use of weights and teaching the use of heavier and wider grip tools for specific daily activities.
Medications
If physical or occupational therapy has not helped, medications can be prescribed.
There are no specific medications for an essential tremor. Instead, the medications prescribed are indicated for other disorders, but the effects of taking them can sometimes reduce tremor. Often prescribed are anti-seizure medications, beta-blockers, Botox, or tranquilizers. Based on your medical history, your physician will determine which medication will be best.
Surgery
Surgery is often a last resort but is considered when medications and therapy haven’t reduced the tremors.
In addition, there are now new treatments on the horizon for essential tremors. The most recent comes in the form of incisionless, focused, ultrasound therapy (see more below) and a new drug-free wristband for wearable therapy. Both provide reduction in tremor without drug interactions or systemic side effects.
Focused ultrasound
Focused ultrasound (FUS) is a new, image-guided treatment for essential tremor. It involves no incisions and is typically performed as an outpatient procedure. FUS is currently offered at the Neurosciences Center on the Anschutz Medical Campus.
Frequently asked questions (FAQs) about essential tremor
Essential tremors do not go away, but instead may change in frequency and amplitude over time.
As one ages, the number of tremors per second may decrease. However, the strength of the tremor often increases over time, interrupting fine motor skills such as eating, gripping tools, or writing.
Although there is no known cure, there are treatments that can help manage essential tremors and improve day-to-day functions.
It is unknown whether essential tremors cause dementia. It has been shown that essential tremors increase with age. At the same time, a person’s likelihood to develop dementia also increases with age. Therefore, as a person with essential tremor ages, they should also be given a thorough assessment with regards to dementia.
Tremors tend to increase with movement so avoiding overuse of the body part with the tremor can help calm the tremor. Also, tremors can be reduced using relaxation techniques, reducing stress, and eliminating caffeine.
Vitamins B1, B6, and B12 are integral in keeping the nervous system in strong working order. And, while essential tremors are more hereditary in nature, a deficiency in vitamin B1, B6, and B12 are known to cause shakiness and tremors in the hands.
Consult your doctor for the proper tests to determine if there is a vitamin deficiency and what vitamins should be supplemented for your essential tremor.
References
National Institute of Neurological Disorders and Stroke (NINDS). Essential Tremor (https://www.ninds.nih.gov/health-information/disorders/essential-tremor)
MedlinePlus: National Library of Medicine. Essential tremor (https://medlineplus.gov/genetics/condition/essential-tremor/)
MedlinePlus: National Library of Medicine. Essential tremor (https://medlineplus.gov/ency/article/000762.htm)