Tremor: essential tremor-symptoms and treatment

 Tremor: essential tremor

 What is essential tremor? 

It is an involuntary tremor that mainly affects the arms, hands and head and possibly the voice and legs. It can come on at any age. It is also called juvenile tremor (if it comes on in children), senile tremor (if it comes on in the elderly), benign tremor (because it is not serious) and familial tremor (because it tends to run in families). The term essential refers to no other disease causing a tremor.

 Is it similar to Parkinson’s disease? 

Essential tremor often gets confused with Parkinson’s, but it is different in that it is most marked when the arms are held out, while the tremor of Parkinson’s is most marked with the hands resting and tends to disappear when the hands are used to do things. Walking is normal with essential tremor but abnormal with Parkinson’s. 

What are the symptoms of essential tremor?

 • A slight tremor begins in one hand and then spreads to the other.

 • The tremor may also affect the head, chin, tongue and only rarely the legs. 

• The head tremor has a ‘yes–yes’ nodding action but can also have a ‘no–no’ shaking action. It can be stopped by supporting the head. 

• It interferes with writing and handling cups of tea, spoons and other objects. 

• A shaky, quivery voice if the vocal cords are affected. • Anxiety, stress, lack of sleep and caffeinated drinks makes the tremor worse. 

• Alcohol tends to make it better. 

• The tremor stops during sleep.

 • Some cases are so mild that it is not diagnosed while in others it can be quite severe.

Who gets essential tremor?

 It is a relatively common problem (affects about 4 per 1000) and has a tendency to run in families. It can come on at any age, although it usually comes on in early adulthood, even in adolescence. The incidence increases with age. 

What is the cause?

 The cause is not exactly known, but certain chemicals that transmit nerve impulses are thought to be present in smaller quantities than normal. 

Does it need special investigation?

 Special expensive investigations are not necessary and are not likely to show up any abnormality. Essential tremor can usually be diagnosed upon observation.

 What are the risks?

 Essential tremor is not a serious illness and most people cope normally throughout life without any disability, even if it comes on in childhood. The condition usually worsens with increasing age. Very rarely some patients can become disabled and surgery may be needed to help them.

 What is the treatment? 

There is no cure. The treatment aims to suppress involuntary movements.

 Explanation and reassurance 

Because most patients cope with essential tremor throughout life, reassurance and education about the tremor are all that are required. Counselling regarding stress management is advisable if appropriate. Medical treatment is usually unnecessary. Caffeine intake should be reduced.

 Alcohol 

Although alcohol helps those with faster tremors, it is not advisable to use it as a treatment. It can aggravate the condition in some people. It should be used in moderation only. 

Medication 

In some patients the tremor can be socially embarrassing, especially when they are very anxious. The beta-blocking drug propranolol and anti-epileptic drugs can be used with good effect in these patients. There are also other drugs that can be effective. 

Surgery 

Surgery to a selected part of the brain has proven to be successful in some people afflicted with more severe tremors. Deep brain stimulation to the thalamus is a new, effective treatment.