Essential tremor

Hands | General Practice | Essential tremor (Disease)


A person with benign essential tremor syndrome has rhythmic muscle activity that mainly affects the hands, head, and voice. The onset of the tremor usually begins in middle age. Essential tremors tend to increase with voluntary movement.

The tremor may also occur in the head (neck), jaw and voice as well as other body regions, with the general pattern being that the tremor begins in the arms and then spreads to these other regions in selected patients. Women are more likely to develop the head tremor than are men. Other types of tremor may also occur, including postural tremor of the outstretched arms, intentional tremor of the arms and rest tremor in the arms.

Causes and risk factors

The cause of benign essential tremor syndrome is unknown, although over half of the cases are inherited. The tremors typically worsen when the hands are being used (kinetic tremor), and reduce significantly or stop altogether when the hands are resting. For some people, the condition worsens if they hold their bodies in certain positions (postural tremor).

Essential tremor generally presents as a rhythmic tremor (4–12 Hz) that is present only when the affected muscle is exerting effort (in other words, it is not present at rest). Any sort of physical or mental stress will tend to make the tremor worse, often creating the false impression that the tremor is of psychosomatic origin.

Diagnosis and Treatment

Therapy depends on the extent of the symptoms and some patients do not require treatment. Medications used to decrease the symptoms include: beta blockers (propranolol/Inderal), anti-seizure medications (primidone/Mysoline, gabapentin/Neurontin, topiramate/Topamax), benzodiazepines (diazepam/Valium, aprazolam/Xanax), and Botox injections. Rarely neurosurgery is necessary for severe symptoms. ...

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