Is Essential Tremor a Progressive Disease?

The main symptoms associated with essential tremor include:

• Uncontrollable rhythmic shaking that occurs for brief period
• Tremors that worsen with movements
• Difficulty in holding or using small objects
• Shaky voice (if essential tremor affects the voice box)
• A nodding head; involves a “yes-yes” or “no-no” motion of the head
• Tremors that worsen during periods of emotional stress, fatigue, temperature extremes, or certain medicines
• Tremors that lessen with rest
• Problems with balancing in rare cases

Essential tremor is not life-threatening, but uncontrollable shaking can reduce a person’s quality of life in the following ways by causing

• Irritation and stress because of the inability to control the affected body part.
• Social embarrassment.
• Increased fatigue.
• Inability to perform daily activity and have professional life.

Although the actual cause of essential tremor is unknown, research suggests the following probable reasons:

• Cerebellum, a part of the hindbrain that controls muscle movements and balance, does not work correctly
• Unusual electrical brain activity in the thalamus (midbrain)
• Inherited genes (a person has about a 50% chance of inheriting the disorder from a parent)

Although essential tremor is more common in older people, it is not a part of the natural aging process.

Factors that worsen essential tremor:

The intensity of essential tremor increases due to many factors including:

• Emotional stress
• Caffeinated drinks
• Alcohol consumption (in some people)
• Fatigue and insufficient sleep
• Physical activity

Although there are no specific medical tests to diagnose essential tremor, a doctor diagnoses essential tremor by evaluating several tests:

• Physical examination
• Personal and medical history of the patient
• Electromyography (EMG) test (to check the electrical activity of the muscles)
• Tests to rule out other causes (X-rays, magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan)
• Neurological examination (to evaluate nervous system functioning)
• Laboratory tests (blood and urine tests to rule out heavy metal poisoning)
• Performance tests (to evaluate the intensity of tremor)
• Dopamine transporter scan (to differentiate essential tremor from Parkinson's disease)

There is no cure for essential tremor, but certain medications, surgery, and lifestyle changes can provide symptom relief and help improve quality of life:

Medications: Most commonly used drugs to relieve symptoms include:

• Beta-blockers: Propranolol, a beta-blocker that is primarily used to treat high blood pressure, reduces essential tremor symptoms. Beta-blockers may not be an option if a patient has asthma or certain heart problems. Side effects include fatigue, light headedness, or heart problems.
• Anti-seizure medications: Primidone, gabapentin, and topiramate may be effective in people who don't respond to beta-blockers. Side effects include drowsiness and nausea, which usually disappear within a short time.
• Anti-anxiety medications: Clonazepam, diazepam, lorazepam, and alprazolam may be used to treat people in whom tension or anxiety worsens the tremors. Side effects can include fatigue or mild sedation.
• Botulinum toxin injections: These are useful in treating head and voice tremors. However, using Botox to treat hand tremors causes weakness in the fingers.

Surgery: Surgery may be an option if tremors are severely disabling and don't respond to medications.

• Chronic thalamic deep brain stimulation (DBS): This includes implanting a stimulating device in the thalamus.
• MR-guided focused ultrasound: This noninvasive surgery involves using focused sound waves that generate heat to destroy the brain tissue in the thalamus.
• Stereotactic thalamotomy: It causes permanent changes in brain activity.

Therapy: Physical or occupational therapy relieve symptoms:

• Physical therapy involves exercises to improve muscle strength, control, and coordination.
• Occupational therapy helps the patient adapt to living with essential tremor.

Adaptive devices: These are external devices that can help change or control the severity of tremors. The devices include neuromodulation devices and tremor cancellation devices that control hand tremors.

Lifestyle changes and home remedies: Lifestyle changes that need to be made to reduce and relieve essential tremors include:

• Reducing caffeine intake
• Avoiding alcohol consumption
• Reducing stress and anxiety
• Using relaxation techniques
• Avoiding uncomfortable postures and actions
• Rehabilitation at work