Essential tremor is the most common type of tremor. Everyone has some tremor present, but the movements are often so small that they can't be seen. Essential tremors are most common in people older than 65.
The exact cause for essential tremor is unknown. Tremors occur when there is a problem with the nerves that supply certain muscles. Some research suggests that the part of the brain that controls muscles movements does not work correctly in patients with essential tremor.
Essential tremor can also occur with other brain and nervous system problems, such as dystonia, parkinsonism, and certain nerve conditions passed down through families.
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 tremor. It often starts in early middle age, but may be seen in people who are older or younger.
The tremor is more likely to be noticed 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 most often involves small, rapid movements -- more than 5 times a second.
Specific symptoms may include:
Shaking or quivering sound to the voice if the tremor affects the voice box
Problems with 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 often get worse as you age
Get worse with stress, caffeine, and certain medications
Not affect both sides of the body the same way
Signs 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:
Implanting a stimulating device in the brain to signals the area that controls movement
An essential tremor is not a dangerous problem, but some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, writing, eating, or drinking.
Sometimes the tremors affect the voice box, which occasionally leads to speech problems.
Calling your health care provider
Call for your health care provider if
You a have a new tremor
Your tremor makes it hard to perform daily activities
You have side effects from in the drugs used to treat your tremor
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.
Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011 Feb;10(2):148-61.
Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine;David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.