Essential tremor is a nervous system disorder that causes involuntary and rhythmic shaking, and this unintentional shaking motion is called a tremor. The hands and forearms are the most affected region. However, it can affect almost any part of the body such as the head, face, tongue, neck, and torso. Generally, trembling occurs most often in hands when a person performs simple tasks such as drinking from a glass or tying shoelaces.
It is not a severe health problem, but it usually aggravates over time and can lead to serious complications in a few people. Other disorders don’t cause essential tremor; however, it is often confused with Parkinson’s disease. Essential tremor can develop at any age but is most common in adults above 40 years.
Some of the signs and symptoms associated with essential tremors include:
Starts slowly and progress more prominently on one side of the body
Tremors worsen with movement
Generally, develop in the hands first, affecting one or both hands
Include a “yes-yes” or “no-no” motion of the head
Maybe worsened by emotional stress, fatigue, caffeine, or temperature extremes.
Typically, the genetic mutation appears to be the cause for more than half of the cases. This is referred to as familial tremor, although, it isn’t very evident what causes essential tremor in people without a known genetic mutation.
Some of the known risk factors for essential tremor include:
The inherited type of essential tremors is an autosomal dominant disorder. A defective gene from one parent is required to pass on the condition. If any one of the parents have a genetic mutation for essential tremor, then children may have 50% chance of developing this disorder.
It is more common in people above 40 years
This nervous disorder is not a life-threatening condition, but it may worsen over time. If the tremors become very severe, then you may find it hard to
Hold a cup or glass without spilling
Put on makeup or shave
Talk properly if your voice box or tongue is affected
The doctor will collect a thorough medical history, family history and symptoms and conduct a physical examination. There are no specific medical tests to diagnose essential tremors, however, diagnosing is often a matter of ruling out other conditions that could be causing the symptoms. Thus, the doctor may suggest the following tests:
The doctor may test nervous system functioning including evaluating the patients:
Muscle strength and tone
Ability to feel certain sensations
Posture and coordination
Blood and urine samples may be tested for various factors, including:
Drug side effects
The doctor may further evaluate the patient and may ask to:
Drink from a glass
Hold your arms stretched out
Draw a spiral
If the doctor is still not able to confirm the diagnosis or rule out Parkinson’s disease, then he or she may further ask to do a dopamine transporter scan. This test will help the doctor to find out the difference between the two types of tremors.
Generally, a person with essential tremor who exhibits mild symptoms may not require any treatment. However, if the condition is making it hard to work or perform daily activities, then the doctor may prescribe medications such as:
The doctors may also recommend physical or occupational therapy, where the therapist will teach the person exercises to improve muscle strength, control, and coordination.
Occupational therapists help a person to adapt to living with essential tremors and may suggest adaptive devices to lessen the impact of tremors on your regular activities, including:
Holding heavier glasses and utensils
Wider, heavier writing tools
Surgery may be an option, if tremors are seriously disabling and if the person doesn’t respond to medications.
Deep Brain Stimulation:
It is the most common type of surgery for essential tremors, where a long thin electrical probe is inserted into the portion of the brain that causes tremors. A wire from the probe travels under the skin to a pacemaker-like device (neurostimulator) implanted in the chest. This device transmits painless electrical pulses to interrupt signals from the thalamus that may be causing tremors.
Problems with motor control, speech or balance, headaches, and weakness. Side effects settle away after some time or adjustment of the device.
Focussed Ultrasound Thalamotomy:
This is non-invasive surgery where focussed sound waves are used to connect the skin and skull. These waves produce heat to destroy brain tissue in a specific region of the thalamus to stop a tremor. The surgeon with aid of magnetic resonance imaging targets the right part of the brain and ensure that the sound waves are producing the exact amount of heat required for the procedure.
This surgery makes a lesion that may result in permanent changes to brain function. Altered sensation, trouble walking or movement. Although, most complications go away on their own or are mild enough that they don’t interfere with the quality of life.