Essential tremor

What is essential tremor?

Essential tremor (ET) is a neurological disorder that causes your hands, head, trunk, voice, and/or legs to shake rhythmically. It is often confused with Parkinson disease.

ET is the most common trembling disorder that people experience. Everyone has some ET, but the movements usually cannot be seen or felt. When tremors are noticeable, the condition is classified as ET.

ET is most common among people older than age 65, but it can affect people at any age.

What causes ET?

ET can occur in different people for different reasons:

  • Familial essential tremor. In most people, the condition seems to be passed down from a parent to a child. If your parent has ET, there is a 50% chance that you or your children will inherit the gene responsible for the condition.
  • Essential tremor related to another disorder. Sometimes, a tremor is a symptom of another neurological disorder, such as Parkinson disease or dystonia. Sometimes, ET is mistaken for these other diseases when they are not present. A health care provider’s careful diagnosis is extremely important.

The cause of ET isn’t known. However, one theory suggests that your cerebellum and other parts of your brain are not communicating correctly. The cerebellum is a part of the brain that controls muscle coordination.

What are the symptoms of ET?

If you have ET, you will experience shaking and trembling at different times and in different situations, but some characteristics are common to all. Here is what you might typically experience:

  • Tremors occur when you move and are less noticeable when you rest.
  • Certain medications, caffeine, or stress can make your tremors worse.
  • Tremors get worse as you age.
  • Tremors don’t affect both sides of your body in the same way.

Here are different signs of essential tremor:

  • Tremors that are most obvious in your hands
  • Difficulty performing tasks with your hands, such as writing or using tools
  • Shaking or quivering sound in your voice
  • Uncontrollable head-nodding
  • In rare instances, tremors in your legs or feet

How is ET diagnosed?

Your rapid, uncontrollable trembling, as well as questions about your medical and family history, can help your health care provider determine if you have familial ET. He or she will probably need to rule out other conditions that could cause shaking or trembling. For example, tremors could be symptoms of diseases, such as hyperthyroidism. Your health care provider might test you for those, as well.

In some cases, the tremors might be related to other factors. To find out for certain, your health care provider may have you try to:

  • Abstain from alcohol; if you’re an alcoholic, trembling is a common symptom.
  • Cut out cigarette smoking.
  • Avoid caffeine.
  • Avoid certain medications


Propanolol and primidone are 2 medications often prescribed to treat ET. Propanolol blocks the stimulating action of neurotransmitters to calm your trembling. Primidone is a common antiseizure medication that also controls the actions of neurotransmitters.

Gabapentin and topiramate are 2 other antiseizure medications that are sometimes prescribed. In some cases, tranquilizers like alprazolam or clonazepam might be suggested.

For ET in your hands, botulinum toxin (Botox) injections have shown some promise in easing the trembling. They work by weakening the surrounding muscles around your hands. For severe tremors, a stimulating device (deep brain stimulator) surgically implanted in your brain may help.

Can ET be prevented?

The specific cause of ET is not known, so scientists are not sure how the condition can be prevented.

Living with ET

ET is usually not dangerous, but it can certainly be frustrating if you have to deal with it. Certain factors can make tremors worse, so the following steps may help to decrease tremors:

  • Avoid alcohol, cigarettes, and caffeine
  • Avoid stressful situations as much as possible
  • Use relaxation techniques, such as yoga, deep-breathing exercises, or biofeedback
  • Check with your health care provider to see if any medications you’re taking could be making your tremors worse.

Talk with your health care provider about other options, such as surgery, if ET starts to affect your quality of life.

When should I call my health care provider?

If you have been diagnosed with ET, talk with your health care provider about when you might need to call. He or she will likely advise you to call if your tremors become worse, or if you develop new neurologic symptoms, such as numbness or weakness.

Key points

  • ET is a neurological disorder that causes your hands, head, trunk, voice, or legs to shake rhythmically. The cause is not known, but it is often passed down from a parent to a child.
  • ET is sometimes confused with other types of tremor, so getting the right diagnosis is important.
  • Tremors tend to be worse during movement than when at rest. The tremors are usually not dangerous, but they can get worse over time.
  • Avoiding things that might make tremors worse, such as stress, caffeine, and certain medications, may be helpful. Medicines can also help control or limit tremors in some people. Severe tremors can sometimes be treated with surgery.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
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Symptoms and Screenings for Essential tremor

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Causes and Preventions for Essential tremor

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