This is a guest article by Dr. Doris Schechter, M.D., INSIGHTEC Medical Director

If it looks like a duck, swims like a duck, and quacks like a duck, then it is probably a duck. People often make decisions based on this logic all the time. When it comes to medical diagnosis, this type of logic may not always be correct.

If you see that your Mom or another person have hands that shake uncontrollably, your first thought may be – Is this just normal for an ageing adult? Or is it something more serious that requires a diagnosis by a neurologist? Some people jump to the conclusion that it may be Parkinson’s disease (PD). However, the statistics tell a completely different story. If you see someone with shaky hands, it is more likely that they have essential tremor (ET). Essential tremor is actually eight times more common than PD and it is estimated that 5% of the population ages 40–60 have ET.

What is Essential Tremor?

According to the National Institute of Neurological Disorders and Stroke, there are more than 20 types of tremor, of which essential tremor is the most common type. 

Symptoms of essential tremor include shaking involuntarily in different parts of the body but is most often in the hands. Tremor is most common among middle-aged and older adults, although symptoms may begin early in a person’s life. The tremor progresses over time to the point where daily activities – eating, drinking, writing – become a challenge and often require a caregiver’s support. Jobs and hobbies that require a steady hand can become a struggle or impossible. This type of tremor is called an intentional tremor, which is activity related and interferes with daily activities, especially those that require fine hand movements.

If a friend or a family member has a tremor that is impacting their life, it’s important to get a diagnosis from a Neurologist, specifically a movement disorder specialist. Understanding when the tremor occurs, during activity or at rest, will help the physician determine what type of tremor they have. The physician will also review the patient’s medical history looking at factors such as what medications they are currently taking to understand if this could be contributing to the tremor. To learn more about the symptoms of ET, you can visit GetAGripOnET.com.

The term essential tremor is a misnomer. Many people living with the condition would say that it is NOT essential. In medicine, the word essential means that there is no known underlying cause for a symptom, which is the case for essential tremor. Genetics is understood to be a factor in developing ET. Approximately half of all people with the condition are believed to have inherited it. Although considered a benign disease because tremor is usually the only symptom, unlike Parkinson’s disease, the impact on a person’s  quality of life may not be “benign” at all.

Clinical research has shown that that the abnormal brain activity that causes tremor treated by targeting the thalamus. The thalamus, which means “inner chamber” in Greek, is located in the center of the brain. It has many functions, including being a “relay station” between the cerebellum and the cortex for motor information as well as our sense of balance.

How is tremor from ET different from Parkinson’s?

To distinguish between the two conditions, a neurologist specializing in movement disorders will do neurological testing and evaluate the specific features of the tremor. For example, ET is generally associated with action tremors while PD is associated with a resting tremor as well as other telltale symptoms.

An action tremor occurs with voluntary contraction of a muscle such as when performing a task such as handwriting.

Alternatively, a resting tremor, which is commonly associated with PD, occurs when voluntary muscle activity is absent, for example when the arm/hand are hanging at the side of the body while standing.

The frequency (or repetitions per second) of the tremors also provides information for distinguishing a tremor. In ET, the frequency of the tremor is high and fast, while PD is generally low and slow.

Next Steps for Mom

Tremor may not be life-threatening, however, it can make living an active and independent life difficult. The first step for any person experiencing tremor is to get an accurate diagnosis. The International Essential Tremor Foundation (IETF) maintains a list of movement disorder specialists here https://www.essentialtremor.org/find-a-physician/

During the visit, the physician will test functional limitations such as difficulty with handwriting or the ability to pour water into a cup.  Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.

The good news is that essential tremor is treatable. First medication will usually be prescribed. If medication does not provide satisfactory tremor relief, then focused ultrasound, radiotherapy or deep brain stimulation may be considered as treatment options.


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