Essential tremor is a neurological disorder causing involuntary shaking. It most often affects the hands, head, or voice and impacts daily tasks.
What is essential tremor?
Essential tremor is a neurological movement disorder that causes shaking in the hands, face, voice, or a combination of these body parts. Movement disorders are neurological conditions that affect the speed, fluency, quality, and ease of movement. They can involve involuntary movements that you can't control, or movements that are slower or less coordinated than usual. The AHN team of neurologists that specialize in movement disorders provide multidisciplinary care, advanced diagnostic capabilities, and personalized plans to treat movement disorders.
Essential tremor is the most common type of movement disorder, but it’s often misdiagnosed — if it’s diagnosed at all. The expert neurologists at AHN know how frustrating it can be when everyday tasks, such as eating, become difficult or impossible due to uncontrollable shaking. At AHN, we’ll discuss the condition with you in detail and determine a care plan that supports you.
Movement Disorders Program
The dedicated Movement Disorders Program at AHN offers our patients care and expertise from a multidisciplinary team that’s focused on diagnosing and treating the complex scope of movement disorders.
Why choose AHN for your essential tremor
We specialize in diagnosing and treating essential tremor and other complex movement disorders. We’ve helped many patients improve their symptoms and quality of life. Using a personalized care approach that focuses on your concerns, we’ll help you overcome the challenges you face today and in the future.
Essential tremor symptoms and signs
Essential tremor symptoms are often experienced as repeated shaking that affects one or both sides of your body. The condition often starts in adulthood, but it can affect people at any age. Every person will experience essential tremor symptoms and signs differently, but generally there are some specific issues that are consistent across individuals.
Involuntary (uncontrolled) shaking from essential tremor often:
- Starts slowly and may get more severe over time
- Affects only your hands, head, or voice (not the legs)
- Gets worse when you move (such as drinking a glass of water)
Causes and risk factors
We don’t know what causes people to develop essential tremor. Researchers continue to investigate how the brain and nervous system work together to direct and impact muscle movement — and how to stop the abnormal signals that cause tremors. It's often an inherited condition, meaning if a close family member (like a parent or sibling) has essential tremor, you have a higher chance of developing it. This is often referred to as familial tremor.
Essential tremor screening and diagnosis
Essential tremor is sometimes misdiagnosed as Parkinson’s disease. AHN’s movement disorder specialists have a thorough understanding of essential tremor symptoms and the differences between it and Parkinson’s. Our specialists use a range of diagnostic tests to evaluate your symptoms to offer a precise diagnosis.
No single test can diagnose a movement disorder. After evaluating your symptoms, your doctor may recommend a series of tests to determine if essential tremor is what’s causing them.
Magnetic resonance imaging (MRI)
Diagnosing essential tremor often starts with an MRI. Because essential tremor is a neurological condition, the MRI is necessary to rule out other conditions such as Parkinson's disease, multiple sclerosis, stroke, brain tumors, or even certain medications. The MRI will also help your care team to identify if there are any abnormalities — lesions, tumors, or other structural issues in the brain — that may be causing or contributing to tremors. With this information, your care team can use other tests to determine if an essential tremor is present.
Blood or urine tests
Doctors use blood or urine tests to review your overall health. A blood panel, combined with a urine test, can tell us if there are unusual levels of blood cells, hormones, or other substances that may be causing your symptoms. These tests are primarily used to rule out other conditions that might be causing or mimicking the tremor, and to support the clinical diagnosis.
Neurological tests
The main way to determine if essential tremor is present, is a thorough neurological examination. This involves a series of observations and simple tasks designed to measure your muscle strength and reflexes.
Types and stages of essential tremor
Essential tremor is typically considered a single disorder, but it can show up in different ways and in different parts of the body, so it is often categorized by how it can affect you.
- Classic essential tremor: Most prominently affecting the upper limbs (hands and arms), this type of essential tremor can begin at any age but often peaks in young adulthood and again in later life.
- Essential tremor plus: This is a newer diagnostic category recognizing that some individuals with typical essential tremor also have other mild neurological signs that are not typical of other neurodegenerative diseases (like Parkinson's).
- Specific body part involvement: Sometimes, an essential tremor can occur in other parts of the body. These types of essential tremor include:
- Head tremor (cervical tremor): This type often shows up as an up and down nod or a side-to-side shake of the head. It can occur with or without limb tremor.
- Voice tremor: This type causes a quivering or wavering voice, which can be particularly difficult.
- Leg tremor: This is less common but can happen when standing.
- Truncal tremor: This is a type of tremor that happens in the body's midsection or torso, often when sitting or standing.
- Facial/jaw tremor: This is a less common essential tremor, but can cause involuntary shaking in the jaw, chin or lips.
- Hereditary essential tremor: This is not a distinct type of essential tremor in terms of symptoms but a family history of tremor is very common.
- Childhood-onset essential tremor: When an essential tremor begins in childhood. It can sometimes be misdiagnosed or challenging to diagnose in younger individuals.
Essential tremor staging
Unlike diseases like Parkinson's, where distinct stages are used to describe motor progression, essential tremor does not have a universally accepted, formal staging system. This is partly because its progression can be highly variable and primarily involves the worsening of tremor severity, rather than a predictable sequence of different neurological deficits.
However, we can think about the progression of essential tremor in a less formal staging or severity manner:
- Early/mild stage: The tremor may only be noticeable during specific tasks or when you are stressed. It can affect one hand more than the other initially, and there is minimal functional impairment, but daily activities are mostly unaffected.
- Moderate stage: There is increased frequency and/or amplitude of the tremor at this stage. Some find difficulty with fine motor tasks (e.g., writing, buttoning clothes, using utensils). This is often the stage where individuals seek medical attention and medication is considered.
- Advanced/severe stage: This type of tremor is significant and constant, often affecting both sides of the body and potentially other body parts (head, voice, legs) and makes many daily activities of daily living difficult or impossible without assistance.
It's important to remember that not everyone with essential tremor will progress through these stages at the same rate, or even reach the severe stage. The progression is highly individual.
Essential tremor treatment
Our team of movement disorder specialists has extensive training in diagnosing and treating movement disorders like essential tremor. You may have access to clinical trials studying new ways to treat this condition.
After confirming a diagnosis, our care team provides you with an essential tremor treatment plan that meets your needs. Many patients with essential tremor find that a combination of therapies helps ease their symptoms. We may meet with you regularly to address any symptoms that worsen or change over time.
Treatment options include:
- Medication: Your physician helps determine which medications would most benefit you based on your symptoms and specific challenges. We work with you to find a medication and dosage that addresses your symptoms.
- Physical therapy: Certain exercises or activities may improve essential tremor symptoms. Regular activity can also benefit your health in many ways. Our knowledgeable and caring physical therapists work with you on a customized physical therapy plan.
- Speech or occupational therapy: Our specially trained speech and occupational therapists can help you relearn how to complete daily activities that have become difficult due to symptoms.
- Surgery: Certain patients experience significant symptom relief from neurosurgical procedures, such as deep brain stimulation. Our specialists have performed hundreds of these innovative procedures, which involve surgically implanting electrodes into the brain to regulate impulses.
Essential tremor FAQs
It's common to have questions when you experience new or unusual symptoms. If you've noticed your hands shaking, or you're curious about tremors in general, here are some answers to common questions patients have about tremor symptoms, essential tremor causes, and essential tremor treatment options.
Why are my hands shaking for no reason?
Shaking hands, especially during activities like writing, eating, or holding objects, could be a sign of essential tremor. Essential tremor is a neurological condition that causes involuntary, rhythmic shaking. Many people describe it as a shaky feeling that can be mild or more pronounced. It's not usually caused by underlying illness or nerves, though stress, fatigue, or caffeine can certainly make your tremor more noticeable. While it can be frustrating and even embarrassing, it's generally not a life-threatening condition. If you're experiencing these essential tremor symptoms in your hands, it's always a good idea to talk to your AHN doctor to understand what might be causing them and discuss potential essential tremor treatment approaches.
What causes essential tremors?
The exact essential tremor causes are not fully understood, but current research suggests it's related to abnormal electrical activity in certain parts of the brain that control movement. It's considered a disorder of the nervous system. Causes and contributing factors of essential tremor include:
- Brain circuitry: Scientists believe essential tremor involves problems with communication between different brain regions, particularly those involving the cerebellum (which coordinates movement) and other motor control centers. These disruptions are thought to be among the primary essential tremor causes.
- Genetics: There's a strong genetic component to essential tremor. About half of all people with essential tremor have a family history of the condition, suggesting that certain genes may increase a person's risk. If a parent has essential tremor, there's a higher chance their children might develop it too.
- Age: While essential tremor can occur at any age, it tends to become more common and noticeable as people get older.
- Not related to other conditions: It's important to know that essential tremor is not typically caused by Parkinson's disease, stroke, or other underlying illnesses, though doctors will often check for these to ensure an accurate diagnosis based on your tremor symptoms.
Contact us
To schedule an appointment or learn more about AHN Neuroscience services, call 412-359-8850 if you are in the Pittsburgh region. If you are in the Erie region, please call 814-452-7575.