Essential Tremor

What Is Essential Tremor?

Essential tremor is a condition that affects the nervous system, causing involuntary and rhythmic shaking or trembling. This shaking is often most obvious in the hands and forearms, but essential tremor can also affect the head, voice, face, and rarely the legs.

This movement disorder is not life-threatening. It is sometimes also called benign essential tremor to distinguish it from Parkinson’s disease. Symptoms of essential tremor can still significantly disrupt daily function.

Who Does Essential Tremor Affect?

Essential tremor is the most common type of tremor, affecting up to five percent of people across the world. Experts estimate that essential tremor affects around 10 million people in the United States. This estimate may be low because many people with mild essential tremor may not seek medical diagnosis or treatment.

While essential tremor can affect people of any age, the condition occurs more often in people older than 40 years. Essential tremor disorder may affect men slightly more than women.

Causes of Essential Tremor

Doctors don’t know what causes essential tremor. Scientists think that a disruption in communication between different parts of the brain, especially within networks involving the cerebellum (which controls and coordinates muscle movement), results in these abnormal movements.

Essential tremor can run in families. When it does, it may be described as a familial tremor or hereditary tremor. Around half of all people with essential tremor inherit the condition from one of their parents. The exact genetic change that causes inherited essential tremor has not yet been identified, so there is currently no genetic testing for this condition.

Essential Tremor Symptoms

Essential tremor occurs during active movement (action tremor) or while holding fixed postures or poses (postural tremor). It is much less likely to occur at rest (resting tremor).

Essential tremor typically affects both hands, but one side often shows more symptoms. Symptoms may be mild at first, and may come and go. Tremors may get worse over time; how this happens varies from person to person.

Symptoms of familial essential tremor may appear in people at younger ages than non-inherited forms of essential tremor.

Essential tremor can affect any body part, including:

• Hands and forearms (most common)
• Head
• Arms
• Vocal cords (leading to a soft, shaky, or breathy voice)
• Face
• Legs/feet (rare)
• Trunk

Symptoms of essential tremor vary depending on the affected area of the body. Essential tremor can make activities that require gripping and manipulating small objects difficult, including:

• Dressing
• Drinking
• Eating
• Sewing
• Shaving
• Using tools
• Writing

If the tremor affects the head, neck, or vocal cords, symptoms may include:

• Uncontrollable nodding or bobbing of the head
• Shaking or trembling of the voice while speaking

Factors That Change Essential Tremor Symptoms

Factors that can make essential tremor worse include:

• Caffeine intake or cigarette smoking
• Emotional stress or anxiety
• Exercise, fatigue, or lack of sleep
• Hunger
• Illness
• Specific medications
• Temperature extremes

Factors that can make essential tremor better, include:

• Resting or sleeping
• Practicing anxiety and stress reduction techniques, such as meditation

Alcohol is frequently reported to improve essential tremor. Despite this, doctors do not recommend alcohol as a treatment for people with this condition.

While tremors may ease if you drink alcohol, many people experience more severe tremors when they stop drinking. Alcohol may also interact with medications used to treat essential tremor.

What is the Difference Between Essential Tremor and Parkinson’s Disease?

Essential tremor differs from Parkinson’s disease in several ways. Parkinson’s disease (PD) causes slowed gait, stooped posture, and shuffling feet. Tremors due to PD are slower, rolling movements over a larger range of motion. In contrast, essential tremor causes faster, smaller, non-rolling movements.

Parkinson’s disease tremor occurs at rest, while essential tremor occurs during active movement. There are distinct changes in the brain in patients with Parkinson’s disease that do not occur in patients with essential tremor.

Evaluating and Treating Essential Tremor

Diagnosing essential tremor can be challenging—the condition is often mistaken for Parkinson’s disease, although essential tremor is around eight times more common. The neurologists at Penn Medicine’s Movement Disorders Center are experts in distinguishing between the two conditions.

Learn more about essential tremor diagnosis

Movement disorders specialists at Penn will help you develop a comprehensive treatment plan for your essential tremor—including medications, noninvasive therapies, or surgical procedures—that take your unique needs into account.

Learn more about essential tremor treatment

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Please call 800-789-7366 or make an appointment.

Penn Programs & Services for Essential Tremor