Benign Essential Tremor

(Essential Tremor; Familial Tremor)
  • Definition

    Benign 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
    ET can be socially isolating in some cases. It may interfere with normal daily activities such as writing or speaking.
  • Causes

    For some people, ET is caused by a genetic mutation. For others, the cause is not clear.
  • Risk Factors

    Family 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.
  • Symptoms

    ET 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
    Tremors must not be related to other health conditions in order for someone to have the ET diagnosis.
  • Diagnosis

    You 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.
  • 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
    The following treatment options may be helpful:
    Medication
    You may be prescribed:
    Surgery
    Surgery 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)
  • Prevention

    There is no known way to prevent ET.
  • RESOURCES

    International Essential Tremor Foundation http://essentialtremor.org

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

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

    References

    About essential tremor. International Essential Tremor Foundation website. Available at: http://essentialtremor.org/about-et/. Accessed February 12, 2014.

    Essential tremor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 27, 2013. Accessed February 12, 2014.

    Essential tremor. International Radiosurgery Support Association website. Available at: http://www.irsa.org/essential%5Ftremor.html. Accessed February 12, 2014.

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

    Sadeghi R, Ondo WG. Pharmacological management of essential tremor. Drugs. 2010:70(17):2215-28.

    Smaga S. Tremor. Am Fam Physician. 2003;68(8):1545-1552.

    What is essential tremor? Who gets ET? International Essential Tremor Foundation website. Available at: http://essentialtremor.org/About-ET. Accessed February 12, 2014.

    Xie T, Bernard J, et al. Post subthalamic area deep brain stimulation for tremors: a mini review. Transl Neurodegener. 2012;1(1):20.

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