Essential Tremor
Rhythmic trembling
| Download this episodeActress Katharine Hepburn. Presidents John Adams and John Quincy Adams. Playwright Eugene O’Neill. U.S. Senator Robert Byrd. All of them suffered from essential tremor, a neurological condition that causes a rhythmic trembling of the hands, head, voice or legs. Essential tremor, or ET, affects an estimated 10 million Americans. Because it is inherited, about half of children born to a parent with essential tremor eventually develop it, usually starting in their 30s. ET is often misdiagnosed as Parkinson’s disease but according to the National Institute of Neurological Disorders and Stroke, eight times as many people have ET as have Parkinson’s. One of the biggest problems with essential tremor is the frustration and embarrassment it causes. Eating, bathing and other daily activities can become difficult if not impossible. Many people with ET may become embarrassed to go out in public, choosing to remain isolated in their homes, which can lead to depression.
Begin gradually
Download this episodeThe symptoms of essential tremor begin gradually, usually on one side of the body. The tremor is most likely to be noticed in the hands, although the arms, head, eyelids and other muscles may also be affected. The shaking most often involves small, rapid movements occurring more than five times a second. According to UAMS neurosurgeon Dr. Erika Petersen, essential, when used as a medical term, refers to a symptom that has no known cause. Someone with essential tremor may display a constant side-to-side or back-and-forth nodding of the head. The movement is involuntary, meaning it is done without any efforts to halt it. Dr. Petersen says that although ET isn’t life threatening, its symptoms can worsen over time. As the tremors become more severe, the patient may find it difficult to hold a glass or cup without spilling it. They may not be able to eat normally, to shave or put or makeup and, if the tongue or voice box is affected, to even talk.
A mystery
Download this episodeThe exact cause of essential tremor, a neurological disorder that causes rhythmic shaking, is a mystery. About half of essential tremor cases appear to result from a genetic mutation, although a specific gene hasn’t been identified. This form is referred to as familial tremor. Familial tremor is usually a dominant trait. This 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. Some research suggests that the part of the brain that controls muscle movements does not work correctly in patients with ET. The tremors may occur during movement and may be less noticeable with rest. They may also be aggravated by emotional stress, fatigue, caffeine or extreme temperatures. Unfortunately, shaking in public can make a person with ET embarrassed or uncomfortable, which in turn aggravates the tremor and creates something of a vicious circle.
Everybody has one
Download this episodeEveryone has a mild, barely detectable tremor that is referred to as a physiologic tremor. Unfortunately, there is no medical test to determine if a person has essential tremor. Diagnosing the neurological condition requires a review of the patient’s medical history and a thorough physical examination to rule out any other conditions that could be causing the tremors. Too much caffeine and tobacco or alcohol withdrawal can cause tremors not associated with ET. An overactive thyroid, excessive stress or trauma and certain medications can also cause tremors. A neurological exam may be performed to examine the patient’s muscle strength, gait and ability to feel certain sensations. The patient may be asked to drink from a glass, to hold their arms outstretched or draw a spiral. If the physician is still unsure whether the tremors are the result of ET or something more serious, such as Parkinson’s disease or dystonia, a dopamine transporter scan may be ordered.
Depends on severity
Download this episodeThe method used to treat essential tremor depends on the severity of the patient’s symptoms. If the tremors are mild, treatment may not be necessary. If they begin to interfere with a person’s ability to perform normal tasks or interact socially, certain therapies should be considered. Some medications, including beta blockers and tranquilizers, can reduce the symptoms. Botox injections have been found useful in treating tremors in the head and voice. Physical therapy can help the patient improve their muscle strength and coordination while occupational therapy can reduce the effect of tremors on their daily activities. Patients who don’t respond to medication may want to consider deep-brain stimulation. The procedure involves a surgically implanted, battery-operated medical device called a neurostimulator to deliver electrical stimulation to targeted areas of the brain that control movement, temporarily blocking the nerve signals that cause tremors.Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.