Benign Essential Tremor
(Essential Tremor; Familial Tremor)
Benign essential tremor (ET) is a movement disorder most commonly noticed by shaking in the hands. It occurs in about 5% of older adults. It may also cause shaking of the head, voice, arms, and trunk. It occurs less often in the legs and feet. Two types of tremor are common with ET:
- Postural tremor—shaking in certain positions only, such as with arms outstretched
- Kinetic or action tremor—shaking that gets worse during activities, such as eating or shaving
ET can be socially isolating in some cases. It may interfere with normal daily activities such as writing or speaking.
For some people ET is caused by a genetic mutation, but for others the cause is not clear.
Family history of tremors is the only known risk factor for ET. The condition may occur at any age. It is more likely to occur in teens and people older than 50 years old.
ET is generally not serious, but its severity may vary and worsen over time. Symptoms may include:
- Tremor that occurs when standing or moving the limbs, but not usually at rest
- Uncontrollable, rhythmic movement
- Shaking most common in hands, arms, head, or voice
- Shaking only in certain positions or during activity
- Trouble with fine motor skills, such as drawing, sewing, or playing an instrument
- Shaking that gets worse from caffeine, stress, fatigue, or heat
- Shaking may decrease when using alcohol
- Hearing loss
- Problems with social, functional, or job-related abilities in more severe cases
Tremors must not be related to other health conditions in order for someone to have the ET diagnosis.
Your doctor will ask about your symptoms, and your medical and family history. A physical exam will be done. Attention will be paid to the central nervous system. There are no special tests to diagnose ET. You may have blood, urine, or other tests to rule out other causes, like:
Most people with ET do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:
- Staying well-rested
- Avoiding caffeine
- Avoiding stimulants often found in over-the-counter medications, like cold remedies
- Avoiding temperature extremes
The following treatment options may be helpful:
- Anti-seizure medications
- Botulinum injections
Surgery may be an option in rare cases where tremors are disabling and medications don’t help. Two approaches are possible.
- Deep brain stimulation (DBS)—sends painless electrical pulses to the brain, interrupting faulty signals.
- Thalamotomy—destroys a tiny part of the brain (less commonly performed than DBS)
There is no known way to prevent ET.
International Essential Tremor Foundation
Parkinson Society Canada
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Facts about essential tremor. International Essential Tremor Foundation website. Available at: http://essentialtremor.org/siteresources/data/files/free%20et%20publications/factsheet012013.pdf. Accessed May 22, 2013.
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What is essential tremor? Who gets ET? International Essential Tremor Foundation website. Available at: http://essentialtremor.org/About-ET. Accessed November 12, 2012.
Last reviewed May 2013 by Rimas Lukas, MD; Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.