Essential Tremor

February 8, 2017

Essential Tremor (ET), also known as familial tremor, benign essential tremor, or hereditary tremor is a life-altering condition that turns simple everyday acts of living into tests of ingenuity and perseverance. Writing a letter, getting dressed, eating, applying makeup, shaving and handling tools take on a different perspective for people who have ET.

ET is often confused with Parkinson’s Disease, despite being more common. The rhythmic shaking of ET is very similar with the shaking that Parkinson’s Disease patients experience, but there are no neurological deficits associated with ET.

Essential Tremor is one of the most common of all neurological conditions. It is estimated that four to five million people in the United States alone have essential tremor. In most cases the disease runs in families. The condition is transmitted as an autosomal dominant inheritance, which means that the offspring of an affected individual will have a fifty percent chance of also having the illness.

Essential Tremor is a neurological disorder in which patients exhibit a rhythmic trembling of the hands, head, legs, trunk and/or voice, which is more visible during movement or with arms outstretched, than at rest. It is recognisable when seen in postural (voluntarily maintaining a position against gravity) and kinetic (performing any kind of movement) positions. Thus, essential tremor is considered an “action” tremor. It is not believed to be associated with any disease or condition.

It can affect persons of any age, gender (both genders are equally affected) and race, it can start in adolescence or adulthood and in the majority of cases, it is inherited. The mean age at onset is 45 years. While more commonly seen in older individuals, ET can begin as early as birth. The age of onset, body part(s) affected and the severity of the tremors, typically differ from patient to patient, even within the same family. This difference from patient to patient holds true for benefits received from drug therapy as well. When tremor begins ins the very elderly it has sometimes been called senile tremor The condition is slowly progressive and tremor will worsen overtime. Some individuals may have to change occupations (i.e. dentists and draftsman) or have to take early retirement.


Essential tremor is the most common type of tremor. Everyone has some tremor present, but the movements are often so small that they cannot be seen. Essential tremor affects men and women and is most common in people older than 65.

The exact cause of essential tremor is unknown. Some research suggests that the part of the brain that controls muscle movements does not work correctly in patients with essential tremor.

If an essential tremor occurs in more than one member of a family, it is called a familial tremor. This type of essential tremor is passed down through families (inherited). This suggests that genes play a role in its cause.

Familial tremor is usually a dominant trait. This means that you only need to get the gene from one parent to develop the tremor. It often starts in early middle age, but may be seen in people who are older or younger.

Risk Factors

Genetic mutation – The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. A defective gene from just one parent is needed to pass on the condition.

 Age – Essential tremor is more common in people age 40 and older.


ET can affect various extremities of the body, although 95 percent of cases involve the hands, and can cause occasional, temporary, or intermittent symptoms such as –

  • Rhythmic shaking
  • Difficulty controlling movements
  • Mild gait disturbances
  • Imbalance

The symptoms are often triggered with certain actions, while at rest or while a person is standing. Unfortunately, there is no exact cause for ET, as it can occur in relatively healthy people, both young and old.

There is a genetic component to ET, especially among children. According to the International Essential Tremor Foundation, children who have a parent with ET have a 50 percent change of inheriting the gene, LINGO1, which is associated with the condition.


Essential tremor isn’t life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to –

  • Hold a cup or glass without spilling
  • Eat normally
  • Put on makeup or shave
  • Talk, if your voice box or tongue is affected
  • Write legibly


Medication – Medication is typically the first line therapy for ET, and most patients maintain a good quality of life with this treatment alone. However, up to 30% of ET patients do not respond to medication and may therefore be considered as candidates for surgical treatment. Because the degree of tremor does not always correlate with the overall disability, the number of ET patients who may have significant disability and are refractory to medication is likely underestimated.

 Thalamotomy – Thalamotomy for ET is a surgical procedure involving the use of either stereotactic radiosurgery or radiofrequency (RF) ablation to destroy a small volume of tissue in the thalamus, an area deep within the brain. These treatments target the ventralis intermedius (VIM), a small cluster of cells in the thalamus—only a few millimeters in diameter—that is known to cause the tremor. The target is determined anatomically and identified and delineated on the patient’s MRI scans. During RF ablation procedures, patients remain awake and provide feedback to confirm the targeted location. The physicians use electrical stimulation to generate this patient feedback. After feedback confirms the target, the neurosurgeon performs the ablation—lesion formation—by heating the tissue with radiofrequency energy. Ablation on one side of the brain improves symptoms on the opposite side of the body. Ablation on both sides of the brain is not recommended because it may lead to speech disturbances.

Deep Brain Stimulation – For this procedure, a burr hole is created in the skull to enable insertion of a DBS electrode into the thalamus. The electrode is connected to a neurostimulator (pacemaker device) that is permanently implanted under the skin near the patient’s collar bone. The electrode delivers a low level electrical current to affect the tissue surrounding the DBS electrode’s tip in the VIM nucleus. DBS can be performed on both sides of the brain without the complications of ablation as noted above.

Alternative & Complementary Treatment

Magnesium, like many minerals, is generally low in the diet due to poor soil conditions. Magnesium is so calming that too much of it works as a laxative (like Milk of Magnesia).

B vitamins are nerve vitamins. Niacinamide — a form of vitamin B-3 — has mild anxiety-reducing properties that can provide partial relief from symptoms of essential tremor.

Vitamins E and C, both powerful antioxidants, may help ease tremor in people with Parkinson’s disease. The Parkinson Research Foundation concurs that vitamins E and C with added bioflavonoids, when taken together, can help slow the progression of Parkinson’s symptoms.

Omega-3 fatty acids coat the myelin of the nerves. Omega-3s help keep the neurons healthy and reduce inflammation.  Inflammation may cause symptoms to be worse as it does with most conditions in our body.

Valerian has been used to treat nervous restlessness, anxiety and insomnia for thousands of years, and it continues to be among the most popular herbal remedies to promote relaxation. As with other calming herbs, scientists are unsure as to the actual reason why this herb works, but it is suggested it increase the GABA chemical in the brain.

Lecithin – An essential nutrient, lecithin is a fat found in the cells of the body. Once in the cells, lecithin is converted into acetylcholine, a substance that transmits nerve impulses. As such, a daily supplement of lecithin can help improve nerve function and limit the side effects and symptoms of essential tremor.

Skullcap and Passion Flower – These are also calming like Valerian but can cause dizziness. Therefore, these herbs are not recommended for those prone to dizziness but may be worth a try for those with no prior history.  Starting a lower dose is recommended.

Fava beans are a healthy protein rich with a variety of nutritional elements. The beans contain high concentrations of thiamin, vitamin K, vitamin B-6, potassium, copper, selenium, zinc and magnesium. These nutrients function to support effective neurological processing, which in turn limit shaking associated with the condition.

Mucuna pruriens or cowhage functions in much the same was as fava beans. Cowhage contains a potent amount of nutrients that supports general health and treats a variety of conditions. This supplement also contains levodopa, a chemical dopamine in the brain that regulates the nervous system and helps treat the condition.


Reference ––Essential-Tremor.htm