Essential Tremor (ET)

Page Contents

1 WHAT IS IT?
2 WHAT CAUSES IT?
3 WHY IS IT A PROBLEM?
4 WHAT MAKES US SUSPECT IT?
5 HOW DO WE CONFIRM A DIAGNOSIS?
6 HOW DO WE RULE OTHER DIAGNOSES OUT?
7 HOW DO WE TREAT IT?
8 HOW WELL DO THE PATIENTS DO?
9 WAS THERE A WAY TO PREVENT IT?
10 WHAT ELSE ARE WE WORRIED ABOUT?
11 OTHER HY FACTS?
12 FURTHER READING

WHAT IS IT?

Essential tremor (ET) is a movement disorder that is characterized by a high frequency tremor.

Essential tremor is characterized by a high frequency tremor that is postural. This means that postures (like outstretching one's hands) will worsen the tremor (source) — Essential tremor is characterized by a high frequency tremor that is postural. This means that postures (like outstretching one’s hands) will worsen the tremor (source)

WHAT CAUSES IT?

This condition has a mysterious etiology (its cause is unknown). It does NOT arise form any disease or medication.

WHY IS IT A PROBLEM?

While this condition is not dangerous, an essential tremor can negatively impact the quality of the patient’s life.

WHAT MAKES US SUSPECT IT?

Risk factors

Family history of ET

Initial Presentation

Common Chief Complaints:

Tremor of the hands, legs, and/or face (often bilateral)
Isolated tremor of the head is a possible presentation.

History Of Present Illness

Disease course: this condition may occur at any age and generally is slowly progressive.

Tremor is improved by:

Rest: patients are not tremulous when they are resting
Alcohol: patients may often self medicate with alcohol (which decreases tremor amplitude)

For some reason alcohol helps with the symptoms of ET. Patients may have a history of self medication with alcohol (source)

Tremor is worsened by:

Sustained postures: such as outstretching the arms
During periods of anxiety

Physical Exam Findings

Tremor that is postural in nature (worsens when the arms are outstretched. The tremor can also affect the voice of the patient.

HOW DO WE CONFIRM A DIAGNOSIS?

This condition usually is diagnosed clinically from the exam/history: generally speaking (while many different criteria exist) the diagnosis is made in the absence of any neurological signs/other probably causes of tremor in the patient (i.e. tremor causing diseases/medications). It often is a diagnosis of exclusion.

HOW DO WE RULE OTHER DIAGNOSES OUT?

Parkinson disease is an important diagnosis to rule out in people presenting with a tremor. The tremor in Parkinson disease is different then ET in that it is a resting tremor, often is unilateral, and responds to dopaminergic medications.

HOW DO WE TREAT IT?

Beta-blockers are used to treat ET with propranolol being the classically used medication.

Barbiturates are also used in treating this condition, and primidone is the commonly used medication.

HOW WELL DO THE PATIENTS DO?

This is not a dangerous condition.

WAS THERE A WAY TO PREVENT IT?

N/A

WHAT ELSE ARE WE WORRIED ABOUT?

Hearing impairment is more common in patients with ET (compared to patients with Parkinson disease, source).

OTHER HY FACTS?

This is the most common cause of a postural tremor.