Essential tremor (ET) is a nerve disorder characterized by uncontrollable shaking, or "tremors", in different parts and on different sides of the body. Areas affected often include the hands, arms, head, larynx, or voice box (making the voice sound shaky), tongue, chin and other areas. Rarely, the lower body is affected.
ET is not a life-threatening disorder, unless it prevents a patient from caring for him/herself. Most people are able to live normal lives with this condition -- although they may find everyday activities like eating, dressing or writing difficult, which leads them to withdraw socially. But it is only when the tremors become severe that they actually cause disability.
The term "tremor" is used to describe the uncontrollable shaking associated with ET, but that's a symptom that can be caused by a multitude of different factors and diseases -- including Parkinson's disease, multiple sclerosis, fatigue after exercise, extreme emotional distress, brain tumors, some prescription drugs, metabolic abnormalities, and alcohol or drug withdrawal.
Tremors can be classified as those that occur when:
A person is moving (action tremor).
A person is not moving (rest tremor).
A person attempts to maintain posture against gravity (postural tremor), as in holding arms out in front of his/her body.
Essential tremor is a postural tremor, so symptoms are usually relieved with rest. But as the disorder advances, the tremors of ET may begin to occur when the muscles are relaxed.
What Symptoms Indicate That I Have Essential Tremor Rather Than Another Type?
Uncontrollable tremors that occur for brief periods of time.
A shaking voice.
Tremors that worsen during periods of emotional stress.
Tremors that get worse with purposeful movement.
Tremor lessens with rest.
Tremors are the only symptom, although rarely a person with ET may suffer from balance problems.
When essential tremor (ET) significantly interferes with daily activities, long-term drug treatment is needed. Drugs most commonly used to treat ET include beta blockers and an epilepsy drug called Mysoline.
With the use of medication, people with ET may see improvement in their ability to control tremor, improving functions like drinking from a cup or using food utensils. More specialized motor functions, such as being able to thread a needle, may not improve.
Your health care provider will determine which treatment is best for you based on your medical history. The goal of treatment is to provide maximum improvement in function while minimizing the side effects of drugs.
For people with mild ET, drug therapy may not be necessary. Tremors may be lessened by minimizing exposure to emotional stress and avoiding substances, such as caffeine and nicotine, which may increase tremor. In social situations, a person with mild tremor can take a beta blocker or drink a small amount of alcohol, if such treatments are approved by a doctor.
The beta blocker Inderal has been used to treat ET for many years. Other beta blockers such as Lopressor also may be effective.
It is not clear how beta-blockers reduce tremors, but they may work by blocking nerve impulses to the muscles. Approximately 50%-60% of people taking Inderal experience some improvement in function, but total tremor suppression usually is not achieved. The greatest improvement is in hand tremors and voice tremor. The drugs may be taken once a day (for longer-acting formulation) or twice a day depending upon the formulation used