Author: Howard S. Schub, MD, retired  

Drawn from the work of: Michael Pranzatelli, MD, PhD 

Reviewed: June 2021 

SUMMARY

Essential tremor is a neurological condition that causes hands to shake rhythmically. 

The head, trunk, and voice may also be involved. The cause is not known but is often passed from parent to offspring. It is important not to confuse essential tremor with other types of tremor. Essential tremor is different from Parkinson’s disease or cerebellar tremor.  

The tremors tend to be worse during movement and better at rest. They can be disabling and slowly worsen over time.  

Tremors can be made worse by: 

• Stress 
• Medications 
• Some metabolic conditions 

Tremors can be controlled or limited with: 

• Medications 
• Surgery 
• Adaptive devices 
• Relaxation 

Disorder Overview

DESCRIPTION 

Essential tremor (ET) is a neurological disorder that causes uncontrollable shaking in different parts and different sides of the body. It most often affects the hands. To a lesser extent, the arms, head, and voice can be involved. 

ET can occur during any age. However, it often appears during adolescence or middle age. It is not life threatening, and most people live with the condition. However, for some people, it can interfere with dressing, eating, and writing. 

ET is the most common movement disorder. It affects up to 10 million people in the U.S. 

SIGNS AND SYMPTOMS

There is no medical test to diagnose the disorder. Diagnosis is based on a thorough neurological examination. Lab tests and X-ray tests can eliminate other, similar disorders. 

Common signs include: 

• Involuntary shaking that affects hands more than arms, head, voice, or legs 
• Tremor worse with movement 
• Tremor better with rest 
• Tremor worse with stress 
• Tremor worse with certain medications, such as steroids, stimulants, and asthma medicines 
• Tremor worse with certain metabolic conditions, such as low glucose or high thyroid levels 
• Tremor worse with drug or alcohol withdrawal 

CAUSES

LABORATORY INVESTIGATIONS 

Certain tests may be performed to eliminate other causes of the tremors.

These can include: 

TREATMENT AND THERAPIES  

Mild ET may not need treatment. Sometimes, though, it causes problems in everyday life. In these cases, treatment may improve symptoms. 

Medications for ET 

Medications include: 

Adaptive Devices for ET 

Adaptive devices can help with ET. Examples include: 

• Wrist weights 
• Wide grip writing instruments and utensils 
• Electrical stimulation devices 

Surgery for ET 

Surgery can sometimes be used for ET. 

It may include: 

• Deep brain stimulation (DBS). DBS is a surgical treatment in which an electrode is placed in your brain. It causes painless shocks that disrupt electrical signals. 
• Ablative brain surgery. This destroys parts of the brain. It uses high-frequency ultrasound or direct excision to do so. For instance, the thalamus controls some movements. Destroying part of it can calm or stop the tremors. 

Relaxation Techniques for ET 

Relaxation techniques can calm tremors. Examples include: 

• Yoga 
• Deep breathing 
• Biofeedback 

OUTLOOK

In many children, the symptoms of ET are mild. Treatments may be worse than the symptoms. However, tremors can worsen with age.

Tremors can affect daily life by affecting fine motor activities. They can cause problems with:

• Eating
• Writing
• Speaking
• Balance

Adaptations should be made at school to maximize the educational experience.

RELATED DISORDERS

ET can be confused with: 

Research 

ClincalTrials.gov for Essential Tremor are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.  

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.   

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits.  

Singer HS, editor. Essential tremor. In: Movement disorders in childhood. Philadelphia, PA: Saunders/Elsevier; 2010. p. 133-6.  

International Essential Tremor Foundation. www.essentialtremor.org. Essential tremor [Internet]. NORD (National Organization for Rare Disorders). [cited 2021 May 12]. Available from: https://rarediseases.org/rare-diseases/essential-tremor/  

Benito-Leon J, Louis ED. Update on essential tremor. Minerva Med. 2011; 102:417-440. PMID: 22193375 

Louis ED. “Essential tremor plus”: A problematic concept. Neuroepidemiology.2020:; 54:180-184. PMID: 32023613; https://doi.org/10.1159/000502862