JAMA PATIENT PAGE | Neurology

Essential Tremor
Tremor is a rhythmic, back-and-forth movement of a body part.
People who experience tremor are unable to control the move-
ment. There are several different types and causes of tremor. Tremor Activities affected by essential tremor of the arms and hands
can occur while the body part is at rest (resting tremor) or while the Essential tremor is usually most
body part is actively moving (action tremor). One of the most com- noticeable when performing activities
Getting dressed
mon causes of action tremor is a condition called essential tremor.
Eating and
Symptoms drinking
Essential tremor most commonly affects the arms and hands dur-
ing activities. It is often noticeable while performing tasks such as
drinking from a cup, writing, or reaching for an object. In most cases,
both sides of the body are more or less equally involved. Essential
tremor may also affect the head, causing shaking of the head in a
side-to-side or up-and-down manner. If the voice is involved, there
may be changes in the volume and smoothness of speech. The
tremor of essential tremor usually remains mild and stable for many
years but can slowly worsen over time. Writing and drawing
Spiral drawings
Cause
The underlying cause of essential tremor is not fully understood. The
condition can run in families, and about half of people with essen-
tial tremor have a family member who also has tremor.

Diagnosis
The diagnosis of essential tremor is based on a medical history and
physical examination performed by a health care professional. There
is no single test to confirm the diagnosis. Other common causes of
action tremor—such as side effects of certain medications or an over-
active thyroid gland—should be ruled out.
Treatment
Treatment of essential tremor depends on how severe the tremor
is and whether it is interfering with activities. If the tremor is mild, it
can be monitored over time by a doctor without treatment. Stress
and caffeine intake can worsen tremors and should be minimized
or avoided if possible.
If the tremor begins to interfere with activities, then treatment
may be needed. Medications used to treat essential tremor include
a class of medicines also used for controlling blood pressure
(β-blockers) and some medicines also used to prevent seizures. If
the tremor is not controlled by medications and remains severe, brain
surgery can be considered. One type of brain surgery called deep
brain stimulation involves placing a wire into deep brain struc-
tures and connecting the wire to a small battery-powered device that
Individual without a tremor Individual with essential tremor
is implanted under the skin in the chest. This device can then be pro-
grammed to deliver electrical stimulation to areas of the brain that
control movement and may help to decrease the tremor.
FOR MORE INFORMATION
• National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov/disorders/essential_tremor/essential
_tremor.htm
• International Parkinson and Movement Disorder Society
http://www.movementdisorders.org/MDS-Files1/Resources/PDFs
/Essentialtremorpatientleaflet.pdf
To find this and previous JAMA Patient Pages, go to the Patient
Page link on JAMA’s website at www.jama.com. Spanish
translations are available in the supplemental content tab.

Author: Christopher C. Muth, MD
Sources: American Academy of Neurology, National Institute of Neurological
Disorders and Stroke, International Parkinson and Movement Disorder Society
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