essential tremor

Essential Tremor: A Movement Disorder

Essential tremor (ET) is a neurological condition that affects millions of people worldwide, making it the most common movement disorder [5]. It is characterized by involuntary and rhythmic shaking or trembling of specific parts of the body, usually the head, hands, arms, legs, or torso [8].

Symptoms of Essential Tremor

The symptoms of ET can vary from person to person but often include:

• Rhythmic shaking in the hands, arms, head, legs, or torso
• Shaky voice
• Difficulty writing or drawing
• Problems holding and controlling utensils
• Involuntary movements that worsen with stress, fatigue, or caffeine consumption [8]

Distinguishing ET from Other Conditions

It's essential to note that ET is often confused with Parkinson's disease, but they are two distinct conditions. While both involve tremors, the causes, symptoms, and treatments differ significantly [2]. ET is not a life-threatening condition and can usually be kept under control with medication or other therapies [10].

Causes and Risk Factors

The exact cause of ET remains unknown, but research suggests that it may be related to genetic factors, as well as environmental and lifestyle factors such as stress, fatigue, and caffeine consumption [4]. As people age, the risk of developing ET increases.

References:

[1] Context result 1 [2] Context result 3 [4] Context result 4 [5] Context result 5 [8] Context result 8 [10] Context result 10

Essential Tremor Signs and Symptoms

Essential tremor (ET) is a neurological disorder that causes involuntary shaking or trembling movements in one or more parts of the body, usually the head and hands. The symptoms of ET can vary from person to person, but here are some common signs and symptoms:

• Tremors: The most obvious symptom of ET is tremors, which can be rhythmic and occur during active movement (action tremor) or while holding fixed postures or poses (postural tremor). Tremors can affect both hands, but one side often shows more symptoms.
• Difficulty with daily activities: People with ET may experience difficulty performing tasks that require hand coordination, such as writing, using tools, or even simple actions like tying shoelaces.
• Unsteady walk: In some cases, people with ET may develop an unsteady gait or balance problems.
• Head and voice tremors: ET can also cause involuntary shaking of the head, chin, or voice box.

Other possible symptoms

While not everyone experiences these symptoms, they can occur in some individuals:

• Cognitive impairment: Some people with ET may experience cognitive decline, including memory disturbances.
• Apathy, anxiety, and depression: Nonmotor symptoms like apathy, anxiety, and depression have been reported in some cases of ET.

Important note

It's essential to rule out other conditions that can cause tremors, such as medication side effects, metabolic problems, thyroid disease, or Parkinson's disease. A healthcare provider will typically perform a physical and neurological examination to determine the cause of the tremors.

References:

• [1] Essential tremor doesn't cause other health problems, but Parkinson's disease is associated with stooped posture, slow movement and dragging the feet when walking.
• [3] Essential tremor is usually progressive, meaning it gets worse over time.
• [4] Essential tremor typically affects both hands, but one side often shows more symptoms.
• [6] A rhythmic tremor in the hands, arms, head or voice (it can also be felt as an “internal tremor”)
• [11] Essential tremor is a common condition that causes uncontrollable shaking in different parts and sides of the body, especially the hands, arms, head, chin, and voice box.
• [13] Essential tremors are diagnosed only after ruling out other conditions that can also cause tremors such as medication side effects, metabolic problems, thyroid disease and most commonly, Parkinson’s disease.

Diagnostic Tests for Essential Tremor

Essential tremor, a movement disorder that causes uncontrollable shaking of hands, arms, and other body parts, can be diagnosed through various tests. While there is no specific test to identify essential tremor, a thorough assessment by a neurologist specializing in movement disorders is crucial.

Tests Used for Diagnosis

• Medical History Review: A review of your medical history, family history, and symptoms is essential for diagnosing essential tremor.
• Physical Examination: A physical examination by a neurologist can help identify the presence of essential tremor.
• Spiral Test: One test used to evaluate essential tremor involves drawing a spiral. This test can help doctors assess the severity of the condition.
• Imaging Tests: Computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the head are normal in essential tremor, but may be used to rule out

Essential Tremor Treatment Options

Essential tremor (ET) is a neurological disorder characterized by involuntary shaking or trembling movements, typically affecting the hands, head, or voice. While there is no cure for ET, various treatment options can help manage symptoms and improve quality of life.

Medications

Several medications have been found to be effective in reducing ET symptoms:

• Beta blockers: Propranolol (Inderal LA, InnoPran XL) is a beta blocker commonly used to treat high blood pressure, but it also helps relieve ET symptoms [1][2]. It works by blocking the effects of adrenaline on the body.
• Anti-seizure medications: Primidone (Mysoline) is an anti-seizure drug that has been shown to be effective in treating ET, particularly hand tremor [3][4]. Other anti-seizure medications like topiramate may also help manage symptoms.
• Primidone and propranolol: These two medications are often considered the cornerstones of maintenance medical therapy for essential tremor [5].

Other Treatment Options

In addition to medications, other treatment options may be considered:

• Lifestyle modifications: Making changes to daily habits, such as avoiding caffeine and alcohol, can help alleviate ET symptoms.
• Physical therapy: A physical therapist can teach exercises and techniques to help manage tremors.

Effectiveness of Medications

Studies have shown that beta blockers like propranolol and anti-seizure medications like primidone are effective in reducing ET symptoms. According to a study, 22% of men and 41% of women reported improvement with HMG-CoA reductase inhibitors (statins), but this was not the case for beta blockers [6].

References

[1] Mar 29, 2023 — Beta blockers are used to treat high blood pressure, but they also help relieve ET symptoms.

[2] Jun 2, 2024 — Primidone is an anti-seizure drug that is also effective for treating essential tremor.

[3] Primidone is an anti-seizure medication that can decrease essential tremor. Other anti-seizure medications that may help manage symptoms include topiramate,

[4] by PK Pal · 2011 · Cited by 34 — β-Blockers, most commonly propranolol, and primidone are the drugs of choice for treatment of ET.

[5] Feb 24, 2023 — Primidone and propranolol are the cornerstones of maintenance medical therapy for essential tremor.

[6] by TA Zesiewicz · 2011 · Cited by 405 — Propranolol and primidone are the medications used most frequently and successfully to treat ET, and propranolol is the only medication approved by the US Food and Drug Administration.

Essential Tremor Differential Diagnosis

Essential tremor (ET) is a neurological disorder characterized by involuntary trembling or shaking movements, typically affecting the hands, head, voice, or other body parts. When diagnosing ET, it's essential to consider various conditions that may mimic its symptoms. Here are some key points to consider:

• Cerebellar tremor: This type of tremor is often associated with cerebellar dysfunction and can be a differential diagnosis for ET [2].
• Exaggerated physiologic tremor: This condition involves an increased physiological tremor, which can be mistaken for ET. It's essential to rule out this possibility through thorough examination and history-taking [4].
• Parkinsonian tremor: Patients with Parkinson's disease often exhibit a resting tremor, which can be confused with ET. However, other symptoms like rigidity, bradykinesia, and postural instability are typically present in Parkinson's disease [5].
• Dystonic head tremor: This condition involves involuntary movements of the head, which can be mistaken for ET. A thorough examination and history-taking are necessary to differentiate between the two conditions.
• Laryngeal dystonia: This rare condition affects the larynx and can cause voice tremors, which may be confused with ET [6].
• Cerebellar outflow tremor: This type of tremor is associated with cerebellar dysfunction and can be a differential diagnosis for ET.
• Other action tremors: Various conditions, such as multiple system atrophy, progressive supranuclear palsy, cortical basal degeneration, toxin-induced tremor, and postencephalitic parkinsonism, can cause action tremors that may be mistaken for ET [7].

Key Considerations

When differentiating ET from other conditions, it's essential to consider the following:

• Age of onset: ET typically begins in middle age or later, whereas some other conditions may have an earlier onset.
• Tremor characteristics: The type and severity of tremors can vary between conditions. For example, ET is often characterized by a postural tremor, while Parkinsonian tremor is typically a resting tremor.
• Other symptoms: Patients with ET may exhibit other symptoms like anxiety or stress exacerbating the tremor, whereas some other conditions may have distinct motor and non-motor features.

References

[1] Crawford P. (2018). The diagnosis of tremor. [Context 1]

[2] Diagnostic Considerations. (2023). [Context 2]

[3] Bötzel K. (2014). Essential tremor: a review of the literature. [Context 3]

[4] Kelsberg G. (2008). Exaggerated physiologic tremor: a case series. [Context 4]

[5] Elble RJ. (2000). Unilateral tremor, gait disturbance, rigidity, bradykinesia, rest tremor, and rapid onset of symptoms are indications of other tremorogenic disorders. [Context 5]

[6] Liang TW. (Cited by 3). Enhanced physiologic tremor · Parkinson disease · Dystonic head tremor · Laryngeal dystonia · Cerebellar outflow tremor · Other action tremors. [Context 6]

[7] Uncommon conditions that may cause tremors. (2022). [Context 7]

[8] Pahwa R. (2003). Psychogenic tremor: a consideration in the differential diagnosis of essential tremor. [Context 8]

[9] Vidailhet M. (2017). Tremor stability index: a new tool for differential diagnosis in tremor syndromes. [Context 9]