stroke
Label
Essential Tremor
Definition &CausesSymptomsInvestigations & TreatmentsRisk Factors & PreventionOutcome
Definition and Causes:

Disorder characterized by the uncontrollable shaking (tremor) of the hands and arms and sometimes may also involve the legs, trunk, head, voice, and chin. It is the most common of all movement disorders. The degree of severity of symptoms is variable among affected people. The condition is usually progressive and hereditary, and almost always improves with ingestion of alcohol.

 

Types of Essential Tremors

  • Benign essential tremor: No genetic link (non-hereditary)
  • Familial Tremor: Family history of tremors (inherited)

 

Causes

  • The exact cause for essential tremor is unknown. Tremors occur when there is a problem with the nerves; which is enclosed cable like bundle of axon (slender projection of a nerve cell also called as neuron); that supply certain muscles
  • If an essential tremor (ET) 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 (unit of heredity of a living organism) play a role in its cause
  • In approximately half of cases, essential tremor is inherited. Several different genetic defects may play a role in this condition. Essential tremors (ET) are most common in people older than 65

 

Note: The uncontrollable shaking associated with essential tremors (ET) is not unique to this condition. Many different factors or diseases can also cause tremors, including Parkinson's disease, multiple sclerosis, fatigue after exercise, extreme emotional distress, brain tumors, some prescription drugs, metabolic abnormalities, (change in blood level of some chemicals such as hormones or minerals e.g. sodium) and alcohol or drug withdrawal.

 

Back to Top
Symptoms:

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. The tremors are increased when the patient is focusing on something or concentrating to perform an action such as using a fork, holding a cup or writing with a pen. Shaking most often involves small, rapid movements (more than 5 times a second) and is increased with emotional excitement (e.g. being the centre of attention at a party). Essential tremors (ET) differ from the tremors seen in Parkinson's disease, which tends to produce a resting tremor, i.e. shaking of the hands while sitting calmly.

 

Specific essential tremors (ET) symptoms may include:

  • Head tremor (nodding or side to side movements)
  • Shaking or quivering sound to the voice if the muscles controlling the vocal cords are affected
  • Problems with writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

 

The tremors may:

  • Occur with movement (action-related tremor), and may be less noticeable with rest
  • Comes and go, but often gradually worsens with age
  • Worsens with stress, caffeine, and certain medications

 

Back to Top
Investigations and Treatment:

A detailed history is required including:

  • Family history
  • Duration (how long has it been there)
  • Severity of the tremor (e.g. is writing or fastening buttons affected)
  • Parts of the body involved
  • Relieving or exacerbating factors
  • Review of patient's medications
  • Inquire about any illicit drug use/abuse

 

A physical exam will often show shaking movements, especially when limbs are placed in certain positions (e.g. outstretched arms). 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:

  • Smoking and smokeless (chewing) tobacco
  • Overactive thyroid (hyperthyroidism)
  • Excess alcohol consumption or suddenly stopping alcohol after drinking a lot for a long time (alcohol withdrawal)
  • Excess caffeine consumption
  • Use of certain medications

 

Blood tests and imaging studies such as a CT or MRI scan of the brain are usually normal, and are only done to exclude other diseases, if suspected.

 

TREATMENT:

Treatment may not be needed unless the tremors interfere with the daily activities of living or cause embarrassment.

Patients may be advised to:

  • Avoid factors that may worsen tremor including stress; adopt relaxation techniques
  • Avoid caffeine, nicotine and other stimulants
  • Consult occupational therapist regarding adaptive devices for performing daily activities
  • Get adequate rest/ sleep
  • Use clothing with velcro fasteners
  • Cooking or eating with utensils that have a larger handle
  • Avoid excess use of alcohol to "control" symptoms and seek appropriate medical therapy for worsening symptoms
  • For tremors caused or made worse by a medication, talk to your doctor about stopping the drug, reducing the dosage, or switching. DO NOT change or stop medications on your own
  • Seek additional information/education and resources to better understand the condition and help achieve adequate control on tremors

 

Medications

  • Beta-blockers (e.g. propranolol) may provide some relief in 60-80% of cases
  • Primidone may be tried in those who may not respond to beta-blockers or who are unable to tolerate or use beta blockers. In some patients it may offer upto 50-60% of benefit
  • Patients requiring intermittent control of tremors in social settings may use small quantities of beer or wine prior to the activity, though it is NOT recommended for maintenance therapy

The most commonly used drugs include:

1-Image-Patient-Essential Tremor-Medications-Treatment

 

Surgery:

In severe cases, surgery may be tried. This may include:

  • Deep brain stimulation: In selected cases, a stimulating device can be implanted into a specific area of the brain that is thought to be causing the essential tremor

 

  • Focusing high-powered x-rays on a small area of the brain (stereotactic radiosurgery) procedure carries a small risk of major complications

 

Back to Top
Risk Factors and Prevention:
  • Exact cause is unknown, there is currently no way to prevent it. However, knowing that essential tremor (ET) has a genetic link requires further search for effective treatments and, ultimately, ways to prevent it

 

  • Alcoholic beverages in small quantities may decrease tremors but can lead to alcohol dependence and alcohol abuse, especially if there is a family history of such problems

 

Back to Top
Outcome:

Essential tremor is not a dangerous problem, but some patients find the tremors annoying and embarrassing. Some patients however, may progress to disabling tremors. In general, most have mild to moderate tremors that are not be severe enough to interfere with usual activities such as work, writing, eating, drinking, or can be at least partially controlled with medications to allow relatively normal activity.

 

Complications:

Sometimes the tremors affect the vocal cords which occasionally lead to speech problems.

 

Back to Top
 
Copyright © 2011-2017 Innovate R&D
stroke

educate Are you a Healthcare professional or patient?

Healthcare Professionals would include: Physicians (MD,OD), Physician assistants, Nurses, Pharmacists,Allied Health Workers (PT, OT, SLP, etc), Chiropractors, Paramedics, Optometrists, Dentists, Podiatrists etc, and students within these disciplines.

educate ** You are required to register **

eDucate is committed to optimizing the delivery of health information across the Healthcare continuum. To this end eDucate uses a wide array of learning tools, including Webinars, Quick Review Charts, Graphs, Brochures, Videos and Slide Presentations.

Register and join over 65,000 individuals have leveraged the eDucate portal for their medical information needs during the past 2 years.

Professional Membership Benefits include free access to all archived and upcoming Webinars:

educate DISCLAIMER: This website is owned and operated by The Innovate Research and Development LP (Innovate R&D). All references herein to Innovate R&D shall be deemed to include any subsidiary, affiliate, associate or successor corporation of Innovate R&D. By entering and using this site, you agree to the "Terms of Use"for this website. If you do not agree to these terms and conditions then exit from this site immediately. Although Innovate R&D updates this website regularly with material believed to be accurate at the time of posting, Innovate R&D does not guarantee the accuracy, completeness, timeliness or currency of the material and consequently Innovate R&D expressly disclaims any liability for errors or omissions in the material contained in the website. The Innovate R&D website and all contents are provided as-is, and all representations and warranties, express or implied, relating to the website or the content are disclaimed, including any implied warranty of merchantability, fitness for a particular purpose or non-infringement, as well as any warranty of quality, functionality, accuracy, currency, completeness, reliability, operability, use performance or absence of viruses. In no way or event will Innovate R&D or any party that has been involved in the creation, production, promotion and marketing be liable to you or any other party for perceived direct or indirect damages. You assume all responsibility and risk of loss resulting from the use of our website.