Essential Tremor: Causes, Symptoms, Diagnosis, Treatment, and Prevention
A common movement disorder, essential tremor causes involuntary, rhythmic shaking of various parts of the body, including the hands, arms, head and voice. It is more prevalent in older adults, but it can affect anyone. Although essential tremor is not life-threatening, it can interfere with daily activities and quality of life.
Causes of Essential Tremor
Despite the fact that essential tremor's exact cause is unknown, it is believed to be caused by abnormal activity in certain areas of the brain.
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One-half of people with essential tremor have a family history of the condition, suggesting it may be inherited from one or both parents. But the specific gene or genes involved have not yet been identified.
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Age: Essential tremor becomes more common and severe with advancing age, although it can occur at any stage of life.
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Some studies have suggested that certain toxins, such as pesticides, lead, or mercury, may trigger or worsen essential tremor in some people. However, more research is needed to confirm this hypothesis.
Symptoms of Essential Tremor
In essential tremor, the affected body part shakes when used or in motion. It usually starts gradually and becomes worse over time. Depending on the situation, such as stress, fatigue, caffeine intake or temperature changes, the severity and frequency of the tremor may fluctuate. It is also possible for the tremor to fluctuate throughout the day.
The most commonly affected body parts by essential tremor are:
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Hands and arms: The tremor may make it difficult to perform tasks that require fine motor skills, such as writing, eating, drinking, dressing or using a computer mouse or keyboard.
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Head and neck: The tremor may cause the head to nod up and down or side to side, which may affect vision, speech and swallowing. The tremor may also affect the facial muscles, causing twitching or grimacing.
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Voice: The tremor may affect the vocal cords, causing the voice to sound shaky, hoarse or quivering. The tremor may also affect the breathing, causing shortness of breath or difficulty speaking.
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Other body parts: The tremor may also affect the legs, feet, trunk, tongue or jaw, but this is less common.
Diagnosis of Essential Tremor
In order to diagnose essential tremor, a medical history, physical examination and observation of the tremor are used. A doctor may also ask about family history, medications, alcohol use, and other health conditions that may mimic or cause tremor. To rule out other possible causes of tremor, such as Parkinson's disease, thyroid disorders, stroke or brain tumors, a doctor may also perform some tests.
Treatment of Essential Tremor
A number of treatment options are available to reduce the severity and impact of essential tremor. The choice of treatment depends on the individual's symptoms, preferences, and overall health.
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The use of certain medications to treat high blood pressure, seizures, anxiety, or depression can also help reduce tremor in some people. Beta-blockers, such as propranolol, and anti-seizure drugs, such as primidone, are the most commonly used medications for essential tremor. The medications may, however, cause side effects, including drowsiness, fatigue, nausea, dizziness, and low blood pressure, and may not work for everyone.
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Botulinum toxin injections: Botulinum toxin, also known as Botox, inhibits nerve signals that cause muscles to contract, so it can be injected into the affected muscles to temporarily reduce the tremor. It is commonly used to treat head and voice tremor, although hand tremor may also be treated with this treatment. Injections usually last about three to six months, and the procedure may need to be repeated periodically. It is possible for the injections to cause pain, bruising, weakness, or difficulty swallowing.
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As part of deep brain stimulation (DBS), thin wires called electrodes are implanted in the brain along with a small device called a neurostimulator. By sending electrical impulses to the electrodes, DBS modulates the abnormal brain activity that causes tremor. It is usually reserved for severe cases of essential tremor that are unresponsive to medication or other treatments. The procedure is performed under general anesthesia and requires regular follow-ups and adjustments. Possible risks include infection, bleeding, stroke, seizure or malfunctioning of the device.
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In addition to acupuncture, biofeedback, relaxation techniques, and herbal remedies, some people with essential tremor may also benefit from alternative or complementary therapies. As there is not enough scientific evidence supporting their effectiveness or safety, it is advisable to consult your doctor before trying any of these treatments.
Prevention of Essential Tremor
There is no known way to prevent essential tremor, but some lifestyle changes may help reduce the frequency and severity of the tremor. These include:
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Avoiding or limiting caffeine, alcohol, nicotine and other substances that may worsen the tremor.
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Managing stress and anxiety, which may trigger or aggravate the tremor.
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Getting enough sleep and rest, which may improve the tremor.
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Exercising regularly, which may improve the muscle strength, coordination and balance.
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Using adaptive devices or aids, such as weighted utensils, cups with lids, pens with grips or voice amplifiers, which may make daily activities easier and safer.
