Parkinson's Disease & Related Movement Disorders Association of SOUTH AFRICA

Tel : +27 (0)11 787 8792

ESSENTIAL TREMOR

What is Essential Tremor ?

Essential tremor is a type of involuntary shaking movement in which no cause can be

identified. Involuntary means you shake without trying to do so.

Causes

Essential tremor is the most common type of tremor. In general, tremors occur when there

is a problem with the nerves supplying certain muscles. However, everyone has some

essential tremor but the movements are usually so small that they can't be seen.

The specific cause for essential tremor is unknown. Some research suggests that the

cerebellum, the part of the brain that controls muscles movements, does not work correctly

in patients with essential tremor.

Noticeable essential tremors can be seen at any age but are most common in people older

than 65.

Essential tremor can also occur with other neurological conditions, including dystonia,

parkinsonism, and certain inherited nerve conditions such as Charcot-Marie-Tooth disease.

If an essential tremor occurs in more than one member of a family, it is called a familial

tremor. This type of essential tremor is passed down through families (inherited), which

suggests that genes play a role in its cause.

Familial tremor is usually a dominant trait, which means that you only need to get the gene

from one parent to develop the disorder. It usually starts in early middle age, but may be

seen in people who are older or younger.

Symptoms

The tremor is usually most obvious in the hands, but may affect the arms, head, eyelids, or

other muscles. The tremor rarely affects the legs or feet. People with essential tremor may

have trouble holding or using small objects such as silverware or a pen.

The shaking usually involves small, rapid movements -- more than 5 times a second.

Specific symptoms may include:

Head nodding

Shaking or quivering sound to the voice if the tremor affects the voice box

Difficulty writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

Occur when you move (action-related tremor), and may be less noticeable with rest

Come and go, but generally get worse as you age

Get worse with stress, caffeine, and certain medications

Not affect both sides of the body the same way

Exams and Tests

Your doctor can make the diagnosis by performing a physical exam and asking questions

about your medical and personal history.

A physical exam will show shaking with movement, usually small movements that are faster

than 5 times per second. There are usually no problems with coordination or mental function.

Further tests may be needed to rule out other reasons for the tremors. Other causes of

tremors may include:

Alcohol withdrawal

Cigarette smoking

Pheochromocytoma

Too much caffeine

Use of certain medications

Wilson's disease

Blood tests and imaging studies (such as a CT scan of the head, brain MRI, and x-rays) are

usually normal.

Click on News Flash above to set up a

Google Alert that will email regular News

& Updates on Essential Tremor to you

Essential Tremor

Essential Tremor

Treatment

Treatment may not be necessary unless the tremors interfere with your daily activities or cause embarrassment.

Medicines may help relieve symptoms. How well medicines work depend on the individual patient.

Two medications used to treat tremors include:

Propranolol, a drug that blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline.

Primidone, an antiseizure drug that also controls the function of some neurotransmitters

The drugs can have significant side effects.

Side effects of propranolol include:

Fatigue

Nose stuffiness

Shortness of breath (people with asthma should not use this drug)

Slow heart beat

Side effects of primidone include:

Drowsiness

Difficulty concentrating

Nausea

Problems with walking, balance, and coordination

Other medications that may reduce tremors include:

Antiseizure drugs such as gabapentin and topiramate

Mild tranquilizers such as alprazolam or clonazepam

Blood pressure drugs called calcium-channel blockers such as flunarizine and nimodipine

Botox injections, given in the hand, have been used to reduce tremors by weakening local muscles.

Outlook (Prognosis)

An essential tremor is not a dangerous condition, but some patients find the tremors annoying and embarrassing.

In some cases, it may be dramatic enough to interfere with work, eating, or drinking.

Possible Complications

Severe essential tremor can interfere with daily activities, especially fine motor skills such as writing. Sometimes the tremors affect

the voice box, which occasionally leads to speech problems.

When to Contact a Medical Professional

Call for an appointment with your health care provider if essential tremor interferes with your ability to perform daily activities.

Call your health care provider if you are being treated for this condition and have side effects from the medication, such as fainting,

very slow heart rate, confusion or changes in alertness, lack of coordination, problems walking, and prolonged nausea or vomiting.

Prevention

Stress and caffeine can make tremors worse. Avoid caffeinated drinks such as coffee, tea, and soda, and other stimulants.

Exercise and counseling to reduce emotional stress may also help.

Alcoholic beverages in small quantities may decrease tremors but can lead to alcohol dependence and alcohol abuse, especially if

you have a family history of such problems. How alcohol helps relieve tremors is unknown.

Alternative Names

Tremor - essential; Familial tremor; Tremor - familial

Is It Parkinson's Disease or Essential Tremor?

If you experience an undiagnosed tremor or are concerned that you might be misdiagnosed, seek out the opinion of a Movement

Disorder Specialist for the correct diagnosis and treatment.

The following table summarizes some of the differences between the tremor of PD and ET:

	Parkinson’s Disease (PD)	Essential Tremor (ET)
Symptoms	Those with Parkinson’s will exhibit SOME of the following symptoms: Tremor Rigidity and stiffness of muscles (e.g., stooped posture) Slowness of movement Poor balance and tendency to fall Shuffle (walk in small steps) Numerous non-motor symptoms	Tremor is the only symptom
When Tremors Occur	Resting tremor (when hands are at sides or resting in lap)	Activity tremor (when hands are in use)
Parts of Body Affected	Arms and hands are most prominent Usually NOT the head or voice	Hands Head (e.g., yes-yes or no-no tremors) Voice (causing a shaking or quivering sound)
Responsive to L-Dopa (Sinemet)	Usually yes	No

Website by Affordable WebCreations