Essential tremor

Essential tremor is a condition that affects the nervous system, causing involuntary and rhythmic shaking or trembling. This shaking is often most obvious in the hands and forearms, but essential tremor can also affect the head, voice, face, and rarely the legs. It is sometimes called benign essential tremor to distinguish it from Parkinson’s disease.

Although symptoms of essential tremor can significantly disrupt daily function, effective therapies are available. Penn Medicine has one of the largest movement disorders clinics in the nation, with specialists experienced in caring for people with all types of tremors, including essential tremor.

Who does essential tremor affect?

Essential tremor is the most common type of tremor, affecting up to five percent of people across the world. Experts estimate that essential tremor affects around 10 million people in the United States. This estimate may be low because many people with mild essential tremor may not seek a medical diagnosis or treatment.

While essential tremor can affect people of any age, the condition occurs more often in people older than 40 years. Essential tremor disorder may affect men slightly more than women.

What is the difference between essential tremor and Parkinson’s disease?

Essential tremor differs from Parkinson’s disease in several ways. Parkinson’s disease (PD) causes slowed gait, stooped posture, and shuffling feet. Tremors due to PD are slower, rolling movements over a larger range of motion. In contrast, essential tremor causes faster, smaller, non-rolling movements.

Parkinson’s disease tremor occurs at rest, while essential tremor occurs during active movement. There are distinct changes in the brain in patients with Parkinson’s disease that do not occur in patients with essential tremor.

Doctors don’t know what causes essential tremor. Scientists think that a disruption in communication between different parts of the brain, especially within networks involving the cerebellum (which controls and coordinates muscle movement), results in these abnormal movements.

Essential tremor can run in families. When it does, it may be described as a familial tremor or hereditary tremor. Around half of all people with essential tremor inherit the condition from one of their parents. The exact genetic change that causes inherited essential tremor has not yet been identified, so there is currently no genetic testing for this condition.

Essential tremor occurs during active movement (action tremor) or while holding fixed postures or poses (postural tremor). It is much less likely to occur at rest (resting tremor).

Essential tremor typically affects both hands, but one side often shows more symptoms. Symptoms may be mild at first, and may come and go. Tremors may get worse over time; how this happens varies from person to person.

Symptoms of familial essential tremor may appear in people at younger ages than non-inherited forms of essential tremor.

Essential tremor can affect any body part, including:

• Hands and forearms (most common)
• Head
• Arms
• Vocal cords
• Face
• Legs/feet (rare)
• Trunk

These symptoms can make activities that require gripping and manipulating small objects difficult. It may be hard to drink, eat, and get dressed. Shaving, sewing, writing, and using tools may be challenging.

Tremors that affect your head or neck can cause uncontrollable nodding or head bobbing. If your vocal cords are affected, you may have a shaky or trembling voice.

What may influence your symptoms

Factors that can make essential tremor worse include:

• Caffeine intake or cigarette smoking
• Emotional stress or anxiety
• Exercise, fatigue, or lack of sleep
• Hunger
• Illness
• Specific medications
• Temperature extremes

Factors that can make essential tremor better, include:

• Resting or sleeping
• Practicing anxiety and stress reduction techniques, such as meditation

Alcohol is frequently reported to improve essential tremor. Despite this, doctors do not recommend alcohol as a treatment for people with this condition.

While tremors may ease if you drink alcohol, many people experience more severe tremors when they stop drinking. Alcohol may also interact with medications used to treat essential tremor.