Essential tremor is a neurological condition that causes you to have involuntary and rhythmic shaking (tremor). It can affect almost any part of the body, even the voice box. The hands are most often affected, especially when performing simple tasks such as drinking water from a cup or when using a spoon.
The tremor starts gradually, usually in the hands first (either one or both hands).
You may find it difficult to perform tasks with your hands, such as writing or using tools. Some may experience uncontrollable head-nodding or shaking, or have a quivering voice. The tremor may worsen if you are stressed, fatigued, cold or have taken caffeine.
Symptoms may fluctuate depending on the task that you are doing, your state of mind, emotions and other factors.
Essential tremor is unlikely to cause balance issues even though it may affect the lower parts of your body in rare cases.
Both conditions are a result of the brain aging (neurodegenerative disorder), but differ in many ways:
Tremors can be caused by a variety of conditions or lifestyle factors including
Unfortunately, essential tremor cannot be prevented as our genes play an important role in the development of essential tremor.
There are triggers to avoid to reduce the occurrence of tremors, such as products with caffeine e.g. coffee, tea, certain carbonated drinks and stressful situations as much as possible.
The cause of essential tremor is unknown. However, some researchers believe that the condition is due to the lack of communication between the part of the brain that controls muscle coordination (cerebellum), and other parts of the brain.
About half of essential tremor cases are related to a genetic mutation. If one of your parents has a genetic mutation, the chances of you developing the disorder is 50% higher.
Certain medicines such as corticosteroids, lithium, cyclosporine, valproate etc., caffeine, alcohol or stress can worsen your tremors.
Although the majority of essential tremor cases are hereditary, researchers have yet to identify any gene mutation that accounts for the development of the condition. Hence, genetic testing is not available currently.
A comprehensive neurological examination is needed to confirm the diagnosis. Blood tests and brain imaging could also be ordered to rule out other conditions that may look similar to essential tremor.
Currently, there are no cures for essential tremors. However, it can be controlled by medication and surgery (deep brain stimulation) (More below). Medications such as propanolol, primidone, gabapentin, topiramate and clonazepam are used to manage essential tremor. The choice of medicine depends on the patient’s medical history and preference.
Although some may experience relief of symptoms for about an hour after a glass of wine, it is not recommended to manage symptoms with alcohol. One may end up drinking too much alcohol, leading to other conditions such as obesity, stroke and fatty liver disease.
There are no specific exercises that can help manage essential tremor. It is important that you stay physically active to maintain physical well-being.
People diagnosed with essential tremors do not have a shorter life expectancy.
Candidates for deep brain stimulation (DBS) include those who:
You will be asked to undergo investigations to determine if you are fit for surgery.
A small hole will be made in the skull for small leads to be inserted into the brain. A week later, a device will be implanted under the skin around the upper chest area, below your collarbone. Two to four weeks after the implant surgery, the device is turned on and adjusted to a setting that will best help manage the symptoms.
Regular reviews with be arranged with the care team to monitor the condition
Some may suffer from a bleed in the brain, brain infection, or the leads could be inserted in a different location than intended. The leads could move or the device could malfunction, with some experiencing pain in the area where the device was implanted, infection or the device breaking through the skin.
Over or under stimulation from the device could result in unintended movements, freezing, worsening of balance and gait, speech disturbance, involuntary muscle contractions, numbness and tingling, and double vision.