Essential Tremor – Diagnosis and Treatment
Diagnosis
Examining the Nervous System
Doctors perform a thorough check of the nervous system. They look for problems with reflexes, muscle tone, strength, and how the patient feels sensations in their hands, arms, or other affected areas.
Doctors also review balance, posture, and the way a person moves or walks. They note any signs of bradykinesia, rigidity, or postural instability to rule out other movement disorders like Parkinson’s disease or dystonia.
Laboratory and Chemical Checks
Doctors may order blood and urine tests to rule out other causes of shaking. These tests detect issues linked to thyroid problems, metabolic disorders, medicine side effects, or unusual chemical levels that might cause tremor symptoms.
If doctors suspect a neurological disease or conditions like multiple sclerosis or hyperthyroidism, lab tests provide important information.
Skill and Movement Challenges
Doctors assess tremors by asking the patient to do simple activities. These include holding the arms out, drinking from a cup, drawing spirals, or writing.
These activities show postural tremor and action tremor in the hands, arms, chin, or tongue. If the diagnosis is unclear, doctors may order a dopamine transporter scan to see if the tremor relates to Parkinson’s disease or another neurological disorder.
| Test Type | Purpose |
|---|---|
| Neurological Exam | Checks reflexes, movement, and sensation. |
| Lab Tests | Rules out chemical or metabolic causes. |
| Performance Tests | Observes tremor during movement tasks. |
Treatment
Drug Options
Doctors may prescribe different medications to help people manage tremor symptoms. They often begin with a type of medicine known as a beta blocker, which is commonly used for blood pressure but can also reduce shaking in some individuals.
Beta blockers may not be suitable for people with asthma or heart problems. Common side effects include tiredness and feeling lightheaded.
If beta blockers do not provide enough relief, doctors may recommend anti-seizure medications. These drugs help stabilize nerve signals and may reduce tremors. They can cause drowsiness or stomach upset at first, but these effects usually improve with time.
For people whose tremors are worsened by anxiety or stress, doctors may suggest a benzodiazepine, a type of anti-anxiety medicine. These can help calm the nervous system but may become habit-forming, so they are used with caution.
Botulinum toxin injections may be another option, especially for tremors in the head or voice. The effects typically last up to three months. For hand tremors, these injections may cause finger weakness.
When used for voice tremors, they may cause a raspy voice or mild swallowing difficulty.
Common Medicines for Essential Tremor
| Medicine Type | Possible Side Effects |
|---|---|
| Beta Blockers | Tiredness, dizziness |
| Anti-Seizure Drugs | Drowsiness, nausea |
| Tranquilizers | Sleepiness, risk of dependency |
| Botulinum Toxin Injections | Weakness, raspy voice, swallowing problems |
Therapy Approaches
Physical and occupational therapy help make daily life easier for people with essential tremor. Physical therapists teach exercises to build muscle strength and improve coordination.
These exercises help people gain better control over their movements. Occupational therapists recommend ways to adapt at home, school, or work.
They may suggest special devices, such as heavier cups, wide-grip pens, or wrist weights. These tools help lessen the effects of tremors during daily tasks.
Adaptive Devices That May Help:
- Heavy glasses or utensils
- Wrist weights
- Large, wide-grip writing pens
Therapy does not cure tremor, but it can help people stay independent and manage their activities.
Wearable Electrical Stimulation
Doctors may recommend a wearable nerve stimulation device for essential tremor. These devices are typically worn on the wrist for about 40 minutes, twice each day.
They do not cure tremor but may help make movements steadier for some users. The device gently stimulates nerves and muscles to help control shaking.
Not everyone experiences the same level of relief, but some people report improved daily function.
Key Points:
- Worn on the wrist, similar to a watch
- Used twice per day
- Sends gentle electrical impulses to muscles and nerves
- Improvement varies from person to person
Surgical Procedures
If medicines and therapy are not enough, doctors may suggest surgery. Deep brain stimulation (DBS) is the most common type of surgery for essential tremor.
| Procedure | What Happens | Possible Risks |
|---|---|---|
| Deep brain stimulation (DBS) | Device sends signals to the brain | Speech, balance, or movement problems, headaches, equipment issues |
| Focused ultrasound thalamotomy | Sound waves create small brain lesion | Sensory changes, walking issues, risk of permanent change |
Surgeons place a thin wire into the brain, usually in the thalamus, and connect it to a device under the skin in the chest. The device sends electrical signals that can block the brain signals causing tremors.
Doctors can adjust the device for the best control of tremor. Side effects can include trouble with speech, movement, or balance, but these often improve after the device is adjusted.
Sometimes, people may have headaches or weakness, which usually get better over time. Another surgical option is focused ultrasound thalamotomy. Doctors use sound waves sent through the skull and skin without cutting.
Using MRI to guide the process, they burn a small spot in the brain that causes tremor. The procedure is only done on one side and affects the other side of the body.
Some people may notice changes in feeling, walking, or movement, but these effects are usually mild and often improve.
Lifestyle and Home Approaches
Managing tremors at home often involves practical changes. Reducing caffeine can help because coffee, tea, and some sodas may make tremors stronger.
Doctors advise people to limit or avoid alcohol, since its effects are temporary and can lead to more problems with tremors after it wears off.
Stress and anxiety can make symptoms worse. Learning to relax with meditation, massage, or deep breathing may help lessen tremors. Although stress cannot be removed from daily life, building better coping skills can help.
Changing routines can also help. People might use the hand that shakes less, rely on digital tools like speech recognition, or use debit cards instead of writing checks.
Trying these changes step by step can make daily life easier.
| Lifestyle Tip | Benefit |
|---|---|
| Reduce caffeine | Less shaking |
| Limit alcohol | Avoid rebound tremors |
| Practice relaxation techniques | Manage stress and anxiety |
| Adapt daily activities | Greater control and ease |
Coping and Support
Living with essential tremor can make daily life more challenging and may affect a person’s confidence or self-esteem. Connecting with others who have similar experiences through a support group can provide understanding and encouragement.
Support groups and talking with a counselor or social worker may help improve quality of life and give useful coping tools.
Tips for support:
- Join a support group
- Speak with a mental health professional
- Share challenges and ask for help when needed
How to Get Ready for Your Medical Visit
Steps to Take Before Seeing Your Doctor
Getting organized ahead of time can make your visit more productive. Here are some important things to do:
- Ask about any prep you need to do. When booking the appointment, ask if you should follow any special instructions, such as not eating or drinking before your visit.
- List your symptoms. Write down anything unusual you have noticed, even if it may not be related to the main reason for your visit.
- Note personal details. Include recent stress, big changes in your life, or anything that might be affecting your health.
- Prepare a medication list. Collect the names and doses of any medicines, vitamins, or supplements you take.
- Bring a helper. A trusted friend or family member can help you remember what the doctor says.
- Write down questions. Make a list of what you want to ask. Prioritize the most important questions in case time runs short.
You might want to ask questions like:
| Suggested Questions |
|---|
| What could be causing my symptoms? |
| Are there other possible reasons? |
| What tests should I get? |
| How does this condition usually change over time? |
| What treatments are offered, and which are best for me? |
| How do I manage other health problems at the same time? |
| Are there things I should or should not do? |
| Should I see a specialist, and who would you recommend? |
It’s always okay to ask anything else you are concerned about.
Questions Your Doctor May Ask You
The doctor wants to understand your health history and your symptoms. He or she may ask about:
When your symptoms started
If anyone in your family has similar symptoms
Whether you have had any head injuries
What parts of your body are shaking or affected
If anything makes things better or worse
Clear answers will help your doctor understand your health. This preparation helps you get the most out of your visit.
