Essential Tremor: Symptoms and Treatment

Essential tremor, commonly known as shaking disorder, is a condition characterized by tremors in the hands, arms, or other parts of the body. The frequency of this condition increases with age and is more common between the ages of 10-19 or 50-59. Essential tremor affects approximately 1% of the global population, with an estimated 5% of people over the age of 60 affected. While it is not a dangerous disease, if left untreated, it can interfere with daily activities. There are several treatment options, which can be chosen based on the individual's condition and the severity of the disease. Essential tremor is a slowly progressive condition, which means it may take many years to reach a stage where it significantly impacts one’s quality of life.

What is Essential Tremor (Shaking Disorder)?

Essential tremor is a type of movement disorder that causes involuntary shaking in certain parts of the body. These tremors occur outside of a person’s control and, if left untreated, can be difficult to manage. Although commonly seen in limbs like the hands, arms, and legs, essential tremor can also affect other areas of the body, including the head and vocal cords.

While this condition is not dangerous, it can reduce a person's quality of life. In advanced stages, individuals may struggle with basic tasks such as eating, drinking, and dressing.

Symptoms of Essential Tremor (Shaking Disorder)

Essential tremor is known for causing uncontrollable shaking in parts of the body, with tremor being the most common symptom. Several symptoms associated with tremors include:

• Difficulty with actions like writing or drawing
• A trembling tone of voice while speaking
• Rhythmic shaking of the hands, arms, head, or torso
• Difficulty using utensils like forks and knives

The tremors in essential tremor may manifest in different ways, usually triggered by certain conditions:

• Action Tremor: A type of tremor that occurs during activities, such as reaching for an object.
• Postural Tremor: This tremor arises when a part of the body remains in a fixed position for a while, such as holding the arms up.

Essential tremor often affects both sides of the body, though it may impact one side more than the other.

Causes of Essential Tremor (Shaking Disorder)

The exact causes of essential tremor are not yet fully understood. However, research suggests that it may be linked to changes in specific parts of the brain.

About half of those with essential tremor have a family history of the disorder, suggesting a genetic component. If a parent passes on a mutated gene associated with essential tremor, there is a 50% chance their child will also develop the condition.

This disorder is not contagious and cannot be transmitted from person to person. It is a genetic or spontaneously occurring condition.

How is Essential Tremor Diagnosed?

Essential tremor is diagnosed by a healthcare professional based on the symptoms and a neurological examination. There is no specific test or imaging technique for a definitive diagnosis of essential tremor. Instead, it is diagnosed by ruling out other conditions that may cause similar tremor symptoms. Exclusion of other disorders may involve blood tests or imaging tests.

Tests that help rule out other conditions causing tremors include:

• Blood tests
• CT scans
• Genetic tests
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET)

These tests assist in eliminating other conditions, leading to a diagnosis of essential tremor.

Conditions with symptoms similar to essential tremor include:

• Parkinson's disease
• Stroke
• Multiple sclerosis
• Hyperthyroidism
• Traumatic brain injury

These conditions may cause tremors and could be mistaken for essential tremor.

Treatment of Essential Tremor

There is no definitive cure for essential tremor. If the underlying cause can be identified and addressed, the condition may be treatable. Treatment options include medications, assistive devices, botulinum toxin, deep brain stimulation, and focused ultrasound. If other treatments are ineffective, deep brain stimulation and focused ultrasound may be recommended.

• Medications: Treatment may involve single or combination therapy. Common medications include propranolol (a beta-blocker used to treat anxiety) and primidone (an anti-seizure drug).
• Assistive Devices: Devices designed to reduce tremors, such as peripheral nerve stimulators and vibration devices, can help control shaking.
• Botulinum Toxin: This medication is injected into the muscle to temporarily reduce activity, lessening tremor severity.
• Deep Brain Stimulation (DBS): This surgical procedure involves placing a device in the brain that sends electrical impulses to disrupt the signals causing tremors. DBS can stop tremors on both sides of the body and is typically used as a last-resort treatment when other methods are ineffective.
• Focused Ultrasound: This treatment identifies the area in the brain causing tremors and applies high-frequency sound waves to destroy the targeted tissue. Focused ultrasound can reduce severe tremors and improve quality of life, particularly when other treatments are ineffective.

These treatment methods are chosen based on the individual's condition and may have side effects or complications. The healthcare provider will discuss these risks with the patient to manage them effectively. To ensure the best possible outcome, ongoing communication with the healthcare provider is essential.

How to Prevent Essential Tremor

Essential tremor is primarily hereditary. The main preventive recommendation is to avoid stress. If there is a family history of the condition, individuals should monitor for symptoms and consult a doctor at the first sign, allowing for early intervention before the disease progresses.

Although essential tremor is genetic, it may also occur spontaneously. Certain lifestyle adjustments can reduce the risk of developing the condition:

• Avoid caffeinated beverages
• Minimize exposure to excessive stress and anxiety
• Practice breathing exercises or yoga

If symptoms of essential tremor are observed in oneself or a family member, a visit to a healthcare facility for an examination is recommended. Early diagnosis allows for easier management of the condition. If an individual with essential tremor notices that a medication is worsening their tremors, they should also consult their doctor.