Many people notice it first while holding a cup of tea, writing a cheque, or trying to thread a needle. The hand shakes slightly. At first, it may seem trivial. But over time, the tremor becomes more noticeable, especially when others start pointing it out.
This condition is often called 'essential tremor' (ET), one of the most common movement disorders in the world. Yet, many people remain unaware of it, and some wrongly fear that they have Parkinson’s disease.
The reassuring news is that essential tremors are usually manageable, and most people continue to lead active, productive lives.
What is essential tremor?
Essential tremor is a neurological condition that causes rhythmic shaking, most commonly of the hands. Unlike Parkinson’s disease, the tremor usually appears when the person is using the hands, such as while eating, drinking, writing, or holding objects. The tremor may be mild in some individuals and more prominent in others.
What are the common symptoms?
The hallmark symptom is shaking of the hands during activity. Common situations include difficulty writing neatly, spilling tea or coffee, trouble using a spoon and shaking while holding a mobile phone.
However, essential tremor does not affect only the hands. It can also involve the head (“yes-yes” or “no-no” shaking), voice, jaw or chin and occasionally legs or trunk. Some people have tremors in both hands, while others may initially notice it more in one hand.
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Which age group is affected the most?
Essential tremor can occur at almost any age, including childhood. However, it becomes more common with increasing age and is frequently seen after the age of 40–50 years. Because tremors are more visible in older individuals, many people wrongly assume it is simply a part of ageing.
Are men or women affected differently?
Both men and women can develop essential tremor. Overall prevalence is fairly similar, though some studies suggest that head tremor may be slightly more common in women and severe tremor may be somewhat more frequent in men.
What causes essential tremor?
The exact cause is not fully understood. In many families, the condition runs across generations, suggesting a strong genetic component. A parent with essential tremor may have children who also develop tremor later in life.
However, genetics is not the whole story. Researchers believe that abnormal activity in brain circuits involving the cerebellum, the part of the brain that controls coordination and fine movement, also plays a role.
So, essential tremor is likely caused by a combination of genetic susceptibility, brain circuit dysfunction and possibly environmental influences.
Is essential tremor disabling?
For many people, the tremor remains mild and causes only minor inconvenience. But in some individuals, it can interfere significantly with daily activities such as eating, writing, dressing, applying makeup and public speaking (in voice tremor).
Some people avoid social gatherings because they feel embarrassed while holding a glass or signing documents. Importantly, the emotional and social impact can sometimes be greater than the physical problem itself.
Is essential tremor the same as Parkinson’s disease?
No. Although both conditions involve tremor, they are quite different.
In essential Tremor (ET), tremor occurs mainly during action or posture. Tremor usually affects both hands, head and voice tremor are common and walking and facial expression are generally normal.
In Parkinson's disease (PD), tremor is often more prominent at rest and typically starts on one side. Patients have other symptoms such as slowness, stiffness, reduced arm swing, and facial masking. Head tremor is uncommon.
Because tremor is visible and frightening to many people, individuals with ET are often unnecessarily worried that they have Parkinson’s disease.
Do people with ET have a higher risk of Parkinson’s disease or dementia?
Research suggests that people with essential tremor may have a somewhat higher risk of Parkinson’s disease, mild cognitive problems or dementia and restless legs syndrome.
However, it is important to keep this in perspective. Most people with essential tremor do not develop Parkinson’s disease or dementia and they continue to function normally for many years.
How is essential tremor treated?
Treatment depends on severity. Mild tremor may improve with lifestyle measures such as adequate sleep, stress reduction, limiting excess caffeine and using heavier utensils or weighted pens.
People with moderate symptoms need treatment with medicines. Many patients experience meaningful improvement with drugs.
Advanced therapies are needed for severe, disabling tremors that are not responding to medicines. These include deep-brain stimulation and focused ultrasound therapy.
What is the long-term outlook?
Essential tremor is usually a slowly progressive condition. Tremor may increase gradually over the years, but the pace varies widely.
The good news is that many people continue to work, travel, write, cook, and live independently. Effective treatments are available for those who need them. Tremor can often be significantly reduced.
Essential tremor is common, real, and often misunderstood. It is not merely 'nervousness', nor is it always Parkinson’s disease. Most importantly, people with essential tremor should know that it does not define their future. With proper evaluation, reassurance, and treatment, most individuals can continue to lead normal, fulfilling lives.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
