Shaking hands, neck or voice can mean more than Parkinson’s

At the first sign of shaking in certain parts of the body, such as the hands and head — even in the voice — your initial thought may be that it’s due to Parkinson’s disease. However, these symptoms can also be a sign of a more common condition called essential tremor, which affects an estimated 10 million people in the U.S., according to the International Essential Tremor Foundation (IETF).

Like Parkinson’s, essential tremor is a movement disorder, one of a group of neurological conditions that cause either increased, involuntary movements or a slowing down of movement. Essential tremor is generally not considered dangerous, though it does progress over time. It is eight times more common than Parkinson’s and overall, the most common movement disorder.

While the exact cause of essential tremor is unknown, for many patients there is a family history of the disorder. However, for some essential tremor patients, there is no family connection at all.

Is it essential tremor?

Most often, a primary care physician is the first to evaluate a patient experiencing essential tremor. They may prescribe medication if the tremor begins to interfere with the patient’s daily activities. A neurologist may also help confirm the diagnosis and continue working with the patient to manage the tremor.

“The diagnosis of essential tremor is based on clinical symptoms and is often suspected when a patient has hand tremor — more specifically, what is called an action tremor,” says Dr. Justin Nowell, a Sharp neurologist specializing in movement disorders. “This means the tremor is happening when patients are holding a posture or moving their arms.”

These everyday actions, says Dr. Nowell, can include:

• Writing

• Eating

• Reaching for an object

In stark contrast to these action tremors, a Parkinson’s disease tremor is called a resting tremor, which happens when your muscle is relaxed, such as when your hands are resting in your lap. Unlike action tremors, resting tremors can typically improve with action.

Essential tremor is often present in both hands, but it’s not uncommon for the tremor to be a little worse in one hand compared to the other. While essential tremor is considered a progressive disease — meaning the tremor may worsen over time — its symptoms progress slowly over a matter of many months or even years.

Managing essential tremor

There is no cure for essential tremor, but there are several oral medications to help control it. Dr. Nowell says most patients may have a more than 50% reduction in tremor with one of these treatments.

And while no specific exercises, diets or vitamins have proven effective for the treatment of essential tremor, there are some modifiable factors you can control.

To reduce signs of essential tremor, you should strive to:

• Reduce caffeine.

• Eliminate or reduce nicotine.

• Manage stress.

• Get enough quality sleep.

Patients can also benefit from physical and occupational therapy to help them manage their symptoms.

“With essential tremor, a patient’s balance might be impaired,” says Travis Dennis, PT, DPT, and a lead rehab therapist with Sharp Grossmont Rehabilitation Services. “We can’t make essential tremor go away, but we work on strategies to improve their balance — for example, to help them with everyday tasks, such as buttoning their clothes.”

Advanced treatments available at Sharp Grossmont Hospital

For those patients whose essential tremor cannot be adequately controlled by medication, Sharp Grossmont offers state-of-the-art treatments:

MR-guided focused ultrasound — Using ultrasound waves guided by magnetic resonance imaging (MRI), focused ultrasound technology is a one-time, outpatient procedure that treats a patient’s tremor by pinpointing the specific part of the brain causing the tremor. The procedure is performed inside of an MRI scanner, and the patient is awake the entire time.

Sharp Grossmont is the only provider in the San Diego area offering focused ultrasound for the treatment of movement disorders, such as essential tremor.

Deep Brain Stimulation (DBS) — DBS is a neurosurgical procedure that can also treat and improve your tremor if it is not responding to medication. DBS involves implanting a device that sends low-level electrical signals to help synchronize areas of the brain responsible for the body’s movement. Controlled by the generator, the electrodes produce electrical impulses that override abnormal impulses to control your symptoms.

Regardless of the severity of a patient’s essential tremor, the outlook is generally positive, given the variety of medications and new treatments available to help manage the condition. “For the large majority of patients, there are effective treatments for essential tremor that can reduce, or in some cases, eliminate the tremor entirely,” says Dr. Nowell.

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