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Essential Tremor

Essential tremor is a relatively benign condition, but one that can drastically affect a patient’s everyday life. Our neurologists understand both the challenge of living with essential tremor and dealing with the possible side effects of medication used to treat it.

Understanding Essential Tremor

Essential tremor is a neurological disorder in which tremors or shakes occur without an identifiable cause. The shaking occurs when a person is moving or trying to move, but not while they are at rest. It may first become noticeable while doing normal activities such as pouring a cup of coffee or using a hand tool.

Some degree of tremor is normal for everyone, but in essential tremor patients the shaking may start in one part of the body and progress to include other parts, such as the hands, arms, head, voice box, eyelids or other muscles.

Purposeful movements may make the tremor worse, while avoiding hand movements may suppress the tremor completely. There may be difficulty holding or using small objects (such as silverware or writing utensils).


  • May be occasional (sporadic) and temporary
  • Occur at a rate of about 6 to 10 per second
  • May affect the head, hands, arms, eyelids, voice
  • Less commonly affect the legs and feet
  • May not affect both sides of the body equally
  • Worsen with voluntary movement or emotional stress
  • Disappear during sleep
  • Typically improve with alcohol
  • Are most common in people over 65

Although the cause is unknown, new research shows that one part of the brain, called the cerebellum, does not appear to function properly in patients with essential tremor. Several types of essential tremor have been identified, such as young-onset essential tremor or essential tremor with head tremor. The types of tremor differ in their response to treatment.

Treating Essential Tremor

No single diagnostic or laboratory test can confirm essential tremor. Neurologists will take a detailed history and conduct a complete physical exam to determine if essential tremor, and not another condition, is responsible. A family history of essential tremor may increase the likelihood of developing the condition.

Treatment may not be necessary unless tremors interfere with the ability to perform daily activities or if they are considered embarrassing to the patient.

Medications are helpful in most patients, however they often come with significant side effects.

Recently, injections of botulinum toxin (BOTOX) into the muscles of the hand have been used to reduce tremor by weakening local muscles. Intramuscular BOTOX is mostly useful for cervical tremor (neck) and possibly voice.

If the tremor is severe enough, surgery may also be an option to alleviate the tremor. Such surgery usually involves implanting a device called a deep brain stimulator in the brain to disrupt the electrical signals causing the tremors.

In patients with essential tremor, caffeine and other stimulants should be avoided. Alcoholic beverages in small quantities may markedly decrease tremors but can lead to alcohol dependence if used in excess.

For a referral to a Washington University neurologist or neurosurgeon at Barnes-Jewish Hospital, call 855.925.0631.

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