Essential Tremor: Causes, Symptoms, Diagnosis and Treatment

Overview

Essential tremor is a neurological condition that causes uncontrollable, unintentional, and rhythmic shaking of body parts. The tremors usually occur in the hands, legs, arms, head, tongue, and chin. Although the disorder is not life-threatening, it can be challenging to perform simple, daily tasks, such as tying shoelaces, writing, or drinking a cup of water.

It is easily confused with Parkinson’s disease. Multiple treatment options are recommended by doctors only after a few years of the onset of the disorder. The blog explains essential tremors, their types, causes, symptoms, diagnosis, and various treatment options. 

What is an essential tremor?

As mentioned above, it is a non-life-threatening neurological condition that results in uncontrollable and unintentional tremors in certain body parts, such as arms, legs, chin, head, and tongue. The condition worsens over time and can be extreme for a few patients. 

Anyone can develop an essential tremor, typically seen in patients 40 years and above. 

Patients with essential tremors often live a normal life. Still, they sometimes may find it challenging to complete simple everyday tasks, including writing, opening the door, or fastening shoe laces. Other health conditions do  cause  tremors, and  it is most often confused with Parkinson’s disease. A severe case of the disorder may cause disability. In rare cases, it affects the lower body, such as the legs and feet. It is a common disorder that affects close to 7 million people in the United States.

What are the symptoms of essential tremors?

Patients suffering from essential tremors may experience minor, quick, rapid movements at different intervals, frequencies, and circumstances. The disorder may or may not affect both sides of the body equally. 

Sometimes, patients experience tremors when performing a task like extending their hand. These are called action tremors. The other type of tremor is called tremors at rest. It happens when the person is resting. The tremors can range from minor to severe. The following are some of the common symptoms of essential tremors:

1. The first sign of essential tremor is noticed in the hands
2. Tremors can make the head and neck involuntarily move in different directions, such as up-and-down or side-to-side motion.
3. Certain parts of the face may appear to twitch, such as the eyelids
4. Sometimes, the tremors in the tongue or voice box can give a shaky voice when the person speaks
5. Problems in the gait and balance due to tremors in the legs and feet
6. Tremors that worsen as the person ages
7. Performing everyday tasks becomes difficult

The following are certain factors that briefly worsen the tremors:

1. Emotional stress
2. Fatigue
3. Hunger
4. Change in temperature
5. Caffeinated or alcoholic beverages
6. Cigarettes 

When to seek medical help?

A person should seek medical help if they notice unexplained and involuntary tremors or shaking hands, arms, head, larynx, and neck. It is essential to schedule regular follow-up visits to monitor the condition and adjust medication or treatment options. Meeting their healthcare provider may be beneficial if patients with essential tremor experience worsening symptoms. Also, side effects of medication or treatments should be bought to the doctor’s notice.

What causes essential tremors?

Experts are unaware of the cause of essential tremors for people who do not have an altered or mutated gene. However, most doctors believe there is a miscommunication between the cerebellum and other brain parts. Also, changes in the brain are responsible for essential tremors.

Nearly half the cases of essential tremors can be due to an altered gene, known as familial tremor. If a person has essential tremors due to genetics, there are chances that it can get passed on to the children. It is most common in older people and is not part of the normal ageing process.

Essential Tremor vs. Parkinson’s disease

Many people link tremors with Parkinson’s disease, but the two conditions differ in key ways:

1. Timing of the tremors: Usually, essential tremors of the hands happen when you use your hands. In Parkinson’s disease, tremors are most prominent when the hands are at your sides or are resting in your lap.
2. Associated conditions: While Parkinson’s disease is associated with slow movement, stooped posture and dragging the feet when walking, essential tremor does not lead to other health issues. However, in essential tremors, other neurological symptoms, like an unsteady walk is seen sometimes.
3. Parts of the body affected: In Parkinson’s disease, usually, the tremors start in the hands, and may affect the legs, chin and other parts of the body, Essential tremor mainly involves the head, hands and voice.

Who is at risk of developing essential tremors?

The following are some of the identified risk factors:

1. Altered gene: The inherited variety of essential tremors (familial tremor) is an autosomal dominant disease. An altered gene from just one parent is required to pass on the condition.
2. Age: It is common in people 40 years and above. 

How are essential tremors diagnosed?

Doctors conduct comprehensive neurological and physical exams, examining the tremors for their frequency and amplitude. The amplitude of a tremor refers to the end-to-end distance the hand travels during a tremor. The amplitude increases with the disorder’s progress and may vary due to action or posture.  

Frequency means each shake of the hand , which  is one tremor cycle. Doctors notice how many cycles a patient experiences in one second. Typically, essential tremor causes six to 12 tremor cycles every second, but it slows down as tremor amplitude increases.

A series of tests are performed by doctors, such as MRIs and CT scans, to check if the patient has suffered a stroke or developed a tumour that could lead to tremors. If not, the healthcare provider may check for other underlying health conditions with tremors as symptoms. However, there are no specific blood, urine, or other tests to diagnose the condition. The doctor may also consider other factors such as caffeine, alcohol, stress, thyroid disease, and side effects of medications.

What are the various treatment options for essential tremors?

Essential tremors do not have a cure. However, there are various treatment options to manage the symptoms. Patients with mild tremors may not require any treatment. If the condition worsens and disrupts everyday life or may result in disability, the following are specific treatment options that can help:

Medications

Oral medications can reduce essential tremors. Some of the medicines are mentioned below.

• Beta Blockers: These medications are used to treat high blood pressure. Propranolol is one such beta blocker that relieves tremors in a few patients. Only after doctors prescribe , should a person start including beta blockers, as these may have an adverse effect on the health of asthma and heart patients. Fatigue, dizziness, or heart issues are some of the side effects of beta blockers.
• Anti-seizure medications: Patients who do not respond to beta-blockers may be prescribed anti-seizure medications, such as primidone, gabapentin, and topiramate. Drowsiness and nausea are some side effects that may reduce or disappear after a short period.
• Tranquilizers: Patients with stress levels or anxiety that worsens tremors may need tranquilizers such as clonazepam. It is vital to use discretion as such medication can be addictive or habit-forming. 
• Onobotulinumtoxin A (Botox) injections: These injections can help treat certain types of tremors, particularly head and voice tremors. A series of botox injections improves tremors for nearly three months. Botox used to treat hand tremors may cause weakness in the fingers, and that used for voice tremors may lead to hoarseness in voice and swallowing problems.

2. Adaptive devices: A wearable external device is one of the newest technology that helps essential tremor patients. It can change or control the severity of the tremors. However, people with disabling tremors may not be good candidates. Such devices include wearable neuromodulation devices that let the patient control and tremor cancellation devices that control tremors enabling the patient to perform everyday tasks. Research has found that such devices bring a certain amount of improvement in tremor patients.

Surgery

Essential tremor patients with severe symptoms that fail other treatments may be a good candidate for various surgeries mentioned below:

• Deep brain stimulation (DBS): It is one of the most preferred surgeries among doctors to treat essential tremors. In this procedure, the surgeons insert an electrode into the brain’s thalamus. The electrode is controlled by a pacemaker-type device placed under the skin of the chest, causing minute, painless shocks that disrupt the miscommunication in the brain. The procedure does not destroy brain tissues and can be removed or adjusted at any given time if patients exhibit symptoms when it delivers shocks. The patient needs brain surgery to get it implanted. However, nearly 90% of patients have found moderate relief from this surgery. Some side effects include equipment malfunction, motor control issues, speech or balance issues, headaches, and weakness. 
• Focused ultrasound thalamotomy. This noninvasive surgery involves using focused sound waves that travel through the skin and skull. The waves generate heat to destroy brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to target the correct area of the brain and to be sure the sound waves are generating the exact amount of heat needed for the procedure.

Focused ultrasound thalamotomy creates a lesion that can result in permanent changes to        brain function. Some people have experienced altered sensation, trouble with walking or difficulty with movement. However, most complications go away on their own or are mild enough that they don’t interfere with quality of life.

Other therapies 

• Biomechanical loading: Applying an external pressure to a limb or muscle to control tremors helps. Research shows that repeating the therapy can ease tremors. 
• Physical or occupational therapy: The healthcare provider teaches patients various exercises to improve muscle strength, control, and coordination. The doctor may also suggest adaptive devices or activities minimize the effects of tremors. These activities include using heavier glasses or utensils, wrist weights, and wider, heavier writing tools. 
• Lifestyle modifications: Changing some aspects of life, such as avoiding alcohol and caffeine, preventing stressful situations, and including relaxation techniques, such as yoga, deep-breathing exercises, or the biofeedback method, may reduce tremors. 

Conclusion

Essential tremor is a neurological disorder that can be frustrating to deal with daily. But numerous treatment options can help relieve the symptoms and help the patient lead an everyday life. 

Frequently Asked Questions (FAQs)

Can a person prevent essential tremors?

It is an unpredictable disorder. Therefore, it cannot be prevented or reduce the risk of developing essential tremors.

Is essential tremors a life-long disorder?

It is not a curable but a life-long disorder that doesn’t reduce or disappear.