Essential Tremor

Diagnosis

Diagnosing essential tremor involves reviewing your medical and family history, understanding your symptoms, and performing a physical examination. There are no specific medical tests to diagnose essential tremor; diagnosis is often made by ruling out other conditions that could cause similar symptoms.

Neurological exam

A neurological exam checks how well your nervous system is functioning. During this exam, your healthcare professional may assess:

• Tendon reflexes

• Muscle strength and tone

• Sensory responses

• Posture and coordination

• Walking and balance abilities

Lab tests

Blood and urine tests may be done to identify potential causes or contributing factors such as:

• Thyroid disease

• Metabolic issues

• Medicine side effects

• Chemical imbalances that may trigger tremors

Performance tests

To evaluate the tremor, your healthcare professional may ask you to:

• Drink from a glass

• Hold your arms outstretched

• Write or draw a spiral

If it’s unclear whether the tremor is due to essential tremor or Parkinson’s disease, a dopamine transporter scan may be ordered. This imaging test uses a special injected medicine to visualize dopamine levels in the brain, helping distinguish between these two conditions.

Treatment

Some people with essential tremor may not need treatment if symptoms are mild. However, if tremors interfere with daily tasks or work, treatment options are available.

Medicines

• Beta blockers: Propranolol (Inderal LA, InnoPran XL, Hemangeol) can help control tremors but may not be suitable for people with asthma or certain heart conditions. Possible side effects include fatigue, dizziness, or heart issues.

• Anti-seizure medicines: Primidone (Mysoline), gabapentin (Gralise, Neurontin, Horizant), or topiramate (Topamax, Qudexy XR) may help if beta blockers don’t work. Common side effects include drowsiness and nausea.

• Tranquilizers: Benzodiazepines such as clonazepam (Klonopin) may reduce tremors worsened by stress or anxiety. They can cause sedation and may be habit-forming, so they are used cautiously.

• Nerve-blocking injections: OnabotulinumtoxinA (Botox) can reduce head or voice tremors for up to three months. However, it may cause temporary finger weakness or hoarseness depending on the injection site.

Therapy

Physical and occupational therapy can improve muscle control and help you adapt to tremors. Common aids include:

• Weighted glasses and utensils

• Wrist weights

• Wide-grip pens and heavier writing tools

Nerve stimulation devices

A wearable wristband device, such as Cala Trio or Cala kIQ, uses nerve stimulation to reduce tremors. It’s worn for about 40 minutes twice daily and may provide moderate improvement.

Surgery

Surgery may be an option for severe tremors that do not respond to medications.

• Deep brain stimulation (DBS): A thin probe is placed in the thalamus to send mild electrical signals that interrupt tremor-causing activity. A connected neurostimulator implanted in the chest powers the device. Side effects may include headaches, speech or balance issues, and weakness, though these often improve over time.

• Focused ultrasound thalamotomy: A noninvasive procedure using MRI-guided sound waves to heat and destroy a small area of brain tissue responsible for tremors. It is done on one side of the brain and provides lasting improvement. Some people may experience temporary balance or sensation changes afterward.