Essential Tremor – Causes With Effective Treatment

Essential tremor generally presents as a rhythmic tremor (4–12 Hz) that is present only when the affected muscle is exerting effort (in other words, it is not present at rest). Any sort of physical or mental stress will tend to make the tremor worse, often creating the false impression that the tremor is of psychosomatic origin. It is typical for the tremor to worsen in "performance" situations, such as when making out a check at a checkout stand. ET-related tremors do not occur during sleep, but patients sometimes complain of an especially coarse tremor upon awakening that becomes noticeably less coarse within the first few minutes of wakefulness.

Tremor may be either physiologic or pathologic. Physiologic tremor is a normal variant, occurring at a frequency of 8 to 12 Hz in the hands yet as slow as 6.5 Hz in other body parts during maintenance of a posture.It can be increased by emotions such as anxiety, stress or fear, by exercise and fatigue, hypoglycemia, hypothermia, hyperthyroidism and alcohol withdrawal. When such an increase occurs, physiologic tremor is then called enhanced or exaggerated physiologic tremor. Certain drugs can also exacerbate physiologic tremor. Pathologic tremor is either idiopathic or occurs secondary to some disorders. Essential tremor and parkinsonian tremor are two common types of pathologic tremor.

What causes tremor?

Tremor is generally caused by problems in parts of the brain that control muscles throughout the body or in particular areas, such as the hands. Neurological disorders or conditions that can produce tremor include multiple sclerosis, stroke, traumatic brain injury, and neurodegenerative diseases that damage or destroy parts of the brainstem or the cerebellum. Other causes include the use of some drugs (such as amphetamines, corticosteroids, and drugs used for certain psychiatric disorders), alcohol abuse or withdrawal, mercury poisoning, overactive thyroid, or liver failure.

Essential tremor is a relatively benign condition, affecting movement or voice quality, but with no other effects. It involves a rhythmic, moderately rapid tremor of voluntary muscles. Purposeful movements may make the tremors worse, while avoiding hand movements may make the tremors go away completely. People with essential tremors may have trouble holding or using small objects, such as silverware or a pen.

Treatment

Treatment may not be required if the tremors are mild and do not interfere with daily activity. If the tremors are drug-induced, stopping the medication is usually sufficient. (Never stop a medication without a doctor's supervision.) If tremors are caused by a medical condition such as hyperthyroidism, the treatment will target the underlying condition, and the tremors will likely improve.

For people with very severe tremors surgery can be an option, particularly if drug therapy is no longer effective. In the past the most common surgical procedure was thalamotomy this involves burning away a small part of the brain (the thalamus) which is over active and produces tremors. But the latest surgery is deep brain stimulation. The benefit is that is doesn’t destroy any part of the brain and the side effects are less than those of a thalamotomy. The procedure involves placing very small electrodes into the thalamus and attaching them to a device very similar to a pacemaker placed underneath the collarbone.