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Essential tremor (ET)

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Movement Disorders

Essential Tremor - sometimes referred to as Benign Essential Tremor - is a fine to moderate tremor which has no known cause. Tremors are rhythmic, involuntary, alternating movements which may affect any part of the body.

It may be observed as a "shaking" of the hands, forearms, voice, or other extremities. It can often be seen more clearly when an individual is holding a position against gravity (postural tremor), or during movement (kinetic tremor).

If you're an older adult, you may have dismissed trembling hands or a shaking head as a normal part of the aging process. But it's more likely your shakiness is a symptom of a movement disorder called essential tremor.

Although essential tremor can affect almost any part of your body, trembling occurs most often in your hands, especially when you try to do simple tasks such as drinking a glass of water, tying your shoelaces, writing or shaving. Sometimes, you also may have trembling in your head, voice or arms.

Essential tremor is the most common of the many movement disorders, affecting as  most of them age 60 or older. It's 20 times more common than Parkinson's disease, with which it may sometimes be confused. Unlike Parkinson's disease, however, essential tremor doesn't lead to serious complications. In fact, the word essential in essential tremor means the disorder isn't linked to other diseases.

For some people, essential tremor may be distressing but not debilitating. Others may find that their symptoms make it difficult to work, perform everyday tasks that require fine motor skills or do the things they enjoy. Severe tremors can led to social withdrawal and isolation. Fortunately, a variety of treatments exist that may help bring tremors under control.

Signs and symptoms

Essential tremor often begins gradually. In a few cases it appears during adolescence, then goes into remission only to resurface later. More often, though, symptoms begin in mid- to late-life. The most common symptom is a trembling, up-and-down movement of your hands, although your arms, head and even your tongue and voice box (larynx) may also be affected. In general, you'll have tremors in both hands, but a small percentage of people have tremors in only one hand.

Tremors usually occur only when you engage in a voluntary movement, such as drinking a glass of water, writing or threading a needle. Actions requiring fine motor skills — using utensils or small tools, for example — may be especially difficult. Fatigue, anxiety and temperature extremes make symptoms worse, but tremors usually disappear when you're asleep or at rest.

Some people have relatively mild symptoms throughout their lives, while others develop more severe tremors and increased disability over time. Effects of worsening tremors may include:

  • Difficulty holding a cup or glass without spilling

  • Eating normally

  • Putting on makeup or shaving

  • Talking, if your voice box or tongue is affected

  • Difficulty writing — handwriting may become increasingly large, shaky and illegible

  • The inability to perform actions requiring fine motor skills, such as playing an instrument or drawing

Essential tremor vs. Parkinson's disease
Many people associate tremors with Parkinson's disease, a serious movement disorder. But essential tremor and Parkinson's disease aren't related, and the two conditions differ in three key ways:

  • Essential tremor of the hands typically occurs when your hands are in use. Tremor from Parkinson's is most prominent when your hands are at your sides or resting in your lap.

  • Essential tremor doesn't cause other health problems. Parkinson's, on the other hand, is associated with a stooped posture, reduced swinging of the arms when walking, rigid limbs, slow movement, speech problems other than tremor, and sometimes memory loss.

  • Essential tremor can involve your hands, head and voice. Tremor from Parkinson's typically affects your hands, but not your head or voice.

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