Essential Tremor. Symptoms, Causes, Differences from Parkinson’s
Section content:
- History of the Name
- Causes and Possible Risk Factors 2
- Early signs 4
- Symptoms 2
- Essential Tremor and Parkinson's Disease nWhat is the difference?
- Diagnosis 2
- Short Test for Identifying Essential Tremor
- Treatment of Essential Tremor 2.5
- Rehabilitation
- Forecast 5
- References:
Definition
Essential tremor (familial, hereditary tremor, ET) – rhythmic shaking of certain body parts with relatively constant frequency and variable amplitude, caused by alternating contractions of antagonist muscles 1
History of the Name
Previously, ET was referred to as benign tremor, but this term has been abandoned because the tremor can occur in a severe form and lead to persistent disability in the patient. 2
The adjective “essential,” according to the dictionary, is interpreted as “primary, arising without an apparent cause” 3
My hands are shaking, help!
Causes and Possible Risk Factors 2
- Genetic factors, especially in familial inheritance patterns. Polymorphisms of individual loci are present in 30-70% of cases, among patients with disease onset before the age of 40 – in 80%
- Environmental factors. Their role in the development of the disease continues to be studied.
- Structural anomalies of the brainstem, cerebellum, and neurological disorders, however, their role is not definitively established.
Early signs 4
- Tremor, most pronounced during hand movements, in rare cases – in the legs.
- Difficulties in performing tasks with hands, such as writing or using tools
- Voice changes (tremor)
- Uncontrolled head nodding
Symptoms 2
1) Tremor – a common but not the only disorder in the motor sphere. Below are the characteristic signs that allow distinguishing ET from conditions accompanied by tremor:
- The onset is gradual, may be more noticeable on one side of the body, and can progress asymmetrically.
- Tremor is not consistent in intensity at different times of the day, varying from low-amplitude high-frequency postural tremor of the hands to tremor with much greater amplitude, which is activated in certain body positions in space and movement, and also increases with age. At rest, the severity of symptoms decreases.
- ET most often affects the upper limbs, sometimes involves the head and voice, and in rare cases, the face and torso. Leg tremor is not characteristic of ET.
- Hand tremors and head twitching can be exacerbated by emotional factors, caffeine, or temperature fluctuations.
2) In severe clinical cases, symptoms of tremor may be combined with gait disturbances and cerebellar disorders. Preliminary research suggests that tremor may be a cause of dementia development.
Essential Tremor and Parkinson’s Disease
What is the difference?
Many people associate tremor with Parkinson’s disease, but these are two different conditions, and they differ from each other in several key features:
Type of tremor Essential tremor worsens with active hand movements, such as when picking up a cup or buttoning a button. In Parkinson’s disease, it’s the opposite: involuntary shaking or hand movements are most noticeable when the hands are at rest.
Associated symptoms Essential tremor is not accompanied by other disorders. It is only a tremor, often in the hands. At the same time, tremor in Parkinson’s disease is accompanied by muscle stiffness, slowed movements, slowed walking, and stooping.
Diagnostics 2
The diagnosis of ET is based on clinical research data. The main criteria are:
- The main criterion is bilateral hand tremor in the absence of other signs of neurological disorders (except for the “cogwheel phenomenon” without rigidity), or isolated head tremor without dystonia.
- Secondary criteria include: prolonged course ( > 3 years), familial forms of ET, alleviation of tremor with small doses of alcohol
There are no specific laboratory and instrumental methods for confirming the diagnosis of ET; however, they can be used for differential diagnosis. Tremor can be a symptom of thyroid diseases and may also be caused by disorders associated with high alcohol consumption. To determine possible causes of tremor, temporary abstinence from caffeine and alcohol, as well as dosage adjustment of medications, may be required. Neuroimaging methods (CT, MRI) can be useful for patients suspected of having structural pathology (Wilson’s disease, traumatic brain injury, stroke) DaT scan (visualization of striatal dopamine transporters using single-photon emission computed tomography reliably allows for the accurate differentiation between Parkinson’s disease and essential tremor
Short Test for Identifying Essential Tremor
You will need a piece of paper and a pen.
Position your hand like this: hand in the air, pencil at a 90-degree angle to the paper. Draw a spiral.
Test performed by a healthy person
Test performed by a patient with essential tremor
For an accurate diagnosis, this test is certainly not enough. An in-person consultation with a neurologist is necessary.
Treatment of Essential Tremor 2,5
There are effective treatment methods that can reduce the severity of symptoms, but it is impossible to completely cure ET.
Medication Treatments:
- Beta-blockers (Propranolol). Side effects: quick fatigue, slowed pulse.
- Antiepileptic drugs (Primidone, Gabapentin, Topiramate). Side effects: drowsiness, sluggishness.
- Tranquilizers (Clonazepam). Side effects: drowsiness, risk of dependence and habituation.
- Botulinum toxin injections. They need to be repeated 2-4 times a year and are most effective for patients with head or voice tremor. Side effects: weakness in the limbs.
If medication therapy is ineffective, it is recommended to consider the possibility of surgery with your healthcare provider.
Surgical Methods for Treating Essential Tremor
Deep Brain Stimulation ( Deep Brain Stimulation, DBS)
The method involves implanting an electrical probe into the brain. A neurostimulator is implanted under the skin near the collarbone, transmitting impulses through the probe to the thalamus. Electrical current suppresses the signals that cause tremors. The drawbacks of this surgery include invasiveness (electrodes must be lowered to the target point, piercing brain tissue, causing irreversible fibrotic changes), the risk of infection entering the brain via the electrodes with the potential for brain abscess or encephalitis. In some cases, anatomical features prevent precise targeting, and electrical stimulation after surgery does not suppress the tremor. Wearing a neurostimulator under the skin and electrodes in the brain causes significant discomfort, and maintaining this equipment in working condition (stimulator adjustment, battery replacement) is economically costly.
Thalamotomy
A type of surgical intervention on the brain, in which certain thalamic nuclei are destroyed. The method is invasive, which increases the risk of intra- and postoperative complications.
Treatment with MRI-guided focused ultrasound (MRgFUS, MRgFUS, Neuravive)
Focused ultrasound waves heat a point in the thalamus area and disrupt nerve connections that provoke tremor, while MRI helps target the correct area of the brain with millimeter precision. The distinctive feature of this method, setting it apart from all other approaches, is that doctors can verify if the targeting is correct: heating to low temperatures temporarily “disables” neurons for a few minutes, allowing them to check if the tremor has stopped. Have any complications arisen? If the result is unsatisfactory to the doctors, they shift the target point and recheck the symptoms. The previous point “revives” without any damage. Only after identifying the correct target point does the surgeon increase the ultrasound power and secure the achieved clinical effect. The non-invasive nature, reversibility of changes in the brain during initial impact on “target tissues,” and the absence of the need for anesthesia are advantages of choosing this surgical method. Unwanted clinical manifestations generally do not have a long-term impact on patients’ quality of life. Immediately after surgery, instability in gait, tingling sensations, numbness, or slurred speech may be observed. These manifestations resolve on their own within the first days or months of the postoperative period as the natural fluid exchange in brain tissues is restored.
Bilateral elimination of tremor with focused ultrasound at the V.S. Buzaev Clinic
Rehabilitation
Rehabilitation is an important part of treating essential tremor, as it can significantly improve the patient’s quality of life. The V.S. Buzaev International Medical Centre has created the Community for Patients with Parkinson’s Disease “Semitsvetik”, participation in which will also be beneficial for individuals with essential tremor—one of the movement disorders similar to Parkinson’s disease. Its goal is the motor and social rehabilitation of patients who have encountered these conditions.
Forecast 5
Essential tremor does not reduce life expectancy and is not a disease that directly leads to death. However, ET is characterized by gradual, slow progression over many years, and in rare cases, persistent disability may occur. Sometimes symptoms do not change over time, but with a stable course, we recommend consulting our specialists for a reevaluation of the diagnosis.
The most common cause of death among patients with ET is trauma associated with severe manifestations of tremor.
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List literature :
1 International Essential Tremor Foundation.
2 UpToDate, Essential tremor: Clinical features and diagnosis.
3 Nikiforov A.S. “Neurology. Complete Explanatory Dictionary.” (2010)
4 The Johns Hopkins University, the Johns Hopkins Hospital, and Johns Hopkins Health System. «Essential Tremor Disorder» (2024).
5 International Parkinson and Movement Disorder Society, «Essential Tremor: Essential Facts for Patients» (2024).
Schedule a consultation neurologist at the V.S. Buzaev International Medical Centre® can be reached by the clinic’s phone +7 800 300-84-62
