What Is It?
Tremor is shaky movements of your hands, limbs, head or voice that you can't control. Sometimes tremor is a normal reaction to a situation such as fear, fatigue or anger. It also can be a side effect of too much caffeine, a medication, or withdrawal from a drug or medicine. When tremor occurs during activities and there is no emotional or chemical cause, it can be a sign of a neurological disease called essential tremor.
Essential tremor is most noticeable when your body is in action, such as when you are writing, typing or pouring a beverage. This is one way essential tremor is different from Parkinson's disease, another neurological illness. The tremors of Parkinson's are more noticeable at rest. People with Parkinson's watch their hands shake when they rest in their lap, but when they reach out to grab or hold something, such as a cup of coffee, the shaking stops. Just the opposite happens in people with essential tremor. Their tremors begin when they use their hands, for example, when holding a pen or pencil. Essential tremor often begins in the dominant hand (the one used for writing).
As many as 1 in 4 people develop essential tremor as they age. You are more likely to develop essential tremor if you have a parent or sibling with the condition. People who have an elderly parent or sibling with essential tremor are 5 times more likely to develop tremor than people without affected relatives. If your parent or sibling had essential tremor before age 50, then you are 10 times more likely to get it than average, and it may start at an early age. Essential tremor is 20 times more common than Parkinson's disease. It is much more common in the elderly.
Symptoms
The main symptom is shaking of one or both hands or the head. The shaking is uncontrollable (you can't stop it), but it is not always dramatic. Sometimes, speech trembles. Stress, caffeine and certain medicines may make the tremor worse. Medicines likely to affect the tremor include stimulants such as methylphenidate (Ritalin), lithium (Lithobid and other brand names), valproate (Depacon), various antidepressants and (if you receive it in an excessive dose) thyroid replacement medicine.
Diagnosis
Your doctor will identify essential tremor by its pattern and your history. Features that make the diagnosis likely include shaking that gets worse when you try to maintain one position (such as holding a pen or pencil) and a family history of tremor. Your doctor will review the medications you take to identify any that can cause tremor as a side effect.
Your doctor may want you to have tests for several medical conditions that can cause similar symptoms. If any of these conditions are causing your tremor, you do not have essential tremor. If you have diabetes, tremor can be a symptom of low blood sugar levels. In some cases, tremor can be caused by an excess of certain metals in your body. Your doctor may check blood tests or refer you to an eye doctor for an eye examination to see if you have evidence of excessive copper deposits in your body, a condition called Wilson's disease. Exposure to mercury or arsenic also can cause tremor and your doctor may want to do blood or urine tests for these metals.
Expected Duration
Essential tremor is a permanent condition. The degree of tremor typically worsens as you age. It also can expand from one part of your body to other parts over time.
Prevention
Because no one knows what causes essential tremor, there is no way to prevent it. If stress makes your tremor worse, you can learn ways to reduce your stress.
Treatment
Medicines called beta-blockers – atenolol (Tenormin), propranolol (Inderal) and others – are the most effective treatments. They usually improve the tremor so that it does not interfere with normal activities. In some people, the tremor disappears completely. You need to keep taking the medication or else the tremor will return. Some doctors also prescribe the antiseizure drug primidone (Myidone, Mysoline) or the medicines lorazepam (Ativan) or alprazolam (Xanax). Gabapentin (Neurontin), a drug used primarily for treatment of chronic pain, may help. On rare occasions, doctors have suggested injections of botulinum toxin (Botox) for severe tremors that don't respond to other therapies.
Many people find that drinking small amounts of alcohol temporarily relieves tremor, but you should avoid heavy drinking.
When To Call a Professional
Call your doctor if your tremor starts to interfere with your ability to do your normal, daily activities.
Prognosis
Although treatment can minimize the symptoms, essential tremor slowly gets worse over time. Most people experience only mild or moderate symptoms. In other people, essential tremor can cause substantial disability.
Additional Info
International Tremor Foundation
P.O. Box 14005
Lenexa, Kansas 66285-4005
Toll-Free: 1-888-387-3667
Tel: 913-341-3880
Fax: 913-341-1296
Email: staff@essential tremor.org
http://www.essentialtremor.org/
March of Dimes Birth Defects Foundation
1275 Mamaroneck Ave.
White Plains, NY 10605
Toll-Free: 914-997-4488
http://www.modimes.org/
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: 301-496-5751
Toll-Free: 1-800-352-9424
TTY: 301-468-5981
http://www.ninds.nih.gov/
WE MOVE (Worldwide Education and Awareness for Movement Disorders)
204 W. 84th Street
New York, NY 10024
Email: wemove@wemove.org
http://www.wemove.org/
