Essential tremor: symptoms, causes and treatment

The NHS says a mild tremor not caused by another condition does not usually need treatment, and a GP may want to monitor it to make sure it does not get worse. If a tremor is affecting your life, a GP may prescribe medicine. The NHS says medicine will not cure the tremor, but it often helps to reduce the shaking, and you may need to take it all the time or only when you need it, for example before a stressful situation that causes your tremor to get worse.

The Right Decisions factsheet for GPs in NHS Scotland says many people will require nothing more than reassurance, and reminds clinicians that 1 in 20 people over 65 have the condition and it is rare for it to become disabling. If it is troublesome, first-line therapies are propranolol (a beta-blocker) and primidone. It notes that few people can tolerate primidone because of sedation, that those who become established on it report improvement but had to endure several weeks of side effects, and that primidone can harm a developing baby (teratogenic). Second-line therapies include topiramate, gabapentin and clonazepam, although experience with these is described as disappointing.

For people who are very disabled by drug-resistant tremor, the factsheet says deep brain stimulation or MRI-guided focused ultrasound may be considered. Parkinson's UK says focused ultrasound is available on the NHS for essential tremor. The NHS adds that if a tremor affects the head or voice, you may be offered injections to block the nerves and relax the muscles, and that rarely, brain surgery may be an option for a severe tremor not helped by medicine.

The National Tremor Foundation says essential tremor is considered one of the most common neurological movement disorders and is estimated to be eight to ten times more prevalent than Parkinson's disease. People have a rhythmic trembling of the hands, head, legs, trunk and/or voice. It can occur at any age, in any gender, and can begin as early as birth, though it is more commonly noticed in older people.

The Right Decisions factsheet notes the condition used to be called "benign essential tremor", but the name changed because it is not benign for some patients. It describes onset and progression as subtle.

Right Decisions describes essential tremor as an action tremor that happens with movement of the hand or arm, such as holding a cup or pen, affecting both arms, although it may be asymmetric. The head may also be affected. A variety of other neurological symptoms can occur, which have more recently been labelled "essential tremor plus" syndrome.

Parkinson's UK says essential tremor usually affects your hands and arms but can also affect other parts of the body such as legs, jaw or head. It is usually an action tremor, so it appears when you move. The NHS says a tremor often becomes more noticeable as you get older, when you are stressed, tired, anxious or angry, after drinking caffeine or alcohol or smoking, or if you are very hot or cold.

The National Tremor Foundation says that in the vast majority of cases it is inherited. Right Decisions says around half of patients report an alcohol response and/or a family history. The NHS says some types of tremor run in families, and that some medicines and conditions can also cause a tremor, so you should speak to your GP before stopping any prescribed medicine.

Right Decisions says a number of drugs can exacerbate or cause tremor, and that clinicians should consider whether beta agonist inhalers or nebulisers could be a factor. It says all patients with tremor should be tested for thyroid function.

Many people with a tremor fear Parkinson's disease. Parkinson's UK says essential tremor is different from a Parkinson's tremor, and that you can have both at the same time. Doctors may ask you to carry out a simple action, such as drinking water from a glass, and may ask where on the body the tremor happens, how often, how it affects daily life and whether family members have had a tremor.

Right Decisions says essential tremor is progressive but is not disabling for the majority, although it can cause social embarrassment. Parkinson's UK says it can get worse over time, though for some people it is mild. The NHS says a tremor often becomes more noticeable when you are stressed, tired or anxious, so managing these may help.

The NHS points to the National Tremor Foundation for information on surgery and tremor and on daily living. The foundation also lists support groups and information on topics such as medication and treatments and essential tremor in children and young adults.

The NHS says to see a GP if a tremor is getting worse over time or affecting your daily activities. Your doctor will want to make sure the tremor is not caused by another condition, and may also be able to offer treatment. A GP may examine you and ask about other symptoms, any medicines you take, and your and your family's medical history.

You may be referred to a specialist for further tests if your tremor could be a symptom of a condition such as Parkinson's disease or multiple sclerosis. Parkinson's UK says your GP can refer you to a specialist, who can help you understand which type of tremor you have.

On the NHS, a GP can assess a tremor, test for common causes such as thyroid problems and prescribe first-line medicines. Referral to a neurologist is considered when the diagnosis is unclear or the tremor is hard to manage. Right Decisions says neurologists are happy to see patients for diagnostic clarification or management problems.

Procedures such as deep brain stimulation and MRI-guided focused ultrasound are offered through specialist centres, and the NHS route depends on the service available where you live. Private neurology consultations can offer faster access to assessment. The medical options and their risks are broadly the same whichever route you choose.