What is Tremor

Tremor refers to rhythmic shaking of a body part. There are more than 20 kinds of tremor. Essential Tremor (ET) is the most common. Although called benign essential tremor in the past, it can be far from benign and is most certainly not essential. It may be frustrating, embarrassing, or disabling. People with ET may avoid dining in restaurants or talking in front of others. They may be tired of being told they're "nervous" because their voice quivers or they fear the ordeal of signing a check in public.

Essential tremor is a very common and complex neurologic movement disorder. It is not caused by another neurological condition or the side effect of a medication. ET usually affects the hands, but it may also affect the head and neck (causing shaking), face, jaw, tongue, voice (causing a shaking or quivering sound), the trunk and, rarely, the legs and feet. The tremor may be a rhythmic "back-and-forth" or "to-and-fro" movement produced by involuntary contractions of the muscle. Severity of the tremors can vary greatly from hour to hour and day to day.

Some people experience tremor only in certain positions – this is called postural tremor. Tremor that worsens while writing or eating is called kinetic or action-specific tremor. Most people with ET have both postural and kinetic tremor.  They tend to have less of a tremor at rest. 

Who Gets Tremor?

As many as 1 in 20 people older than age 40 and 1 in 5 people over 65 may have ET. There may be as many as 10 million people with ET in the United States, and many more worldwide. Essential tremor is much more common than most neurologic diseases, with the exception of stroke, and is more common than Parkinson's disease.  There is a large genetic component, with autosomal dominant inheritance.  Many patients report significant family histories of tremor.

Effective treatments are available for ET. The standard medications used are beta blockers, primodone (Mysoline) and topiramate (Topamax).  While small amounts of alcohol can reduce the tremor, the benefits are generally outweighed by the risks of chronic alcoholism.  For patients for whom medications are ineffective of for whom the side effects are intolerable, surgery is often a reasonable option, with quite excellent tremor control. 

Unfortunately, many people are told that “senile tremor” is part of the normal aging process. Experts believe that only a small percentage of people with ET are diagnosed and get help.