As a senior neurologist practicing in Kolkata, I often meet patients who come in worried about shaky hands, difficulty writing, or trembling during daily activities. While many fear Parkinson’s disease, a large number are diagnosed with Essential Tremor (ET)—one of the most common movement disorders worldwide.

This article provides a comprehensive overview of essential tremor—its causes, symptoms, differential diagnosis, and treatment options—along with practical tips for living confidently with the condition.

What Is Essential Tremor?

Essential tremor is a neurological movement disorder marked by involuntary, rhythmic shaking, most commonly affecting the hands.
Unlike Parkinsonian tremor, essential tremor typically occurs during movement or while maintaining posture, not at rest.

Research suggests abnormal activity within the cerebellum and motor pathways contributes to this condition. ET is often hereditary and may progressively worsen over time.

Symptoms of Essential Tremor

Common symptoms include:

• Hand tremor during activity (writing, holding objects, eating)

• Head tremor (“yes-yes” or “no-no” movements)

• Voice tremor (shaky or quivering voice)

• Tremor in the arms, legs, or trunk

Symptoms often worsen with:

• Stress and anxiety

• Fatigue or inadequate sleep

• Caffeine

• Certain medications

Differential Diagnosis: Other Causes of Tremor

Not all tremors are caused by essential tremor. Proper evaluation by a neurologist is essential. The main alternative diagnoses include:

1. Parkinsonian Tremor

• Occurs at rest

• Often begins on one side

• Associated with stiffness, slowed movement, gait changes

2. Dystonic Tremor

• Occurs in people with dystonia

• Tremor is irregular and may improve with a “sensory trick”

• Involves abnormal postures of the head or limbs

3. Cerebellar Tremor

• Caused by cerebellar lesions due to stroke, MS, tumor, or alcohol toxicity

• Tremor occurs at the end of movement

• Often accompanied by balance and coordination issues

4. Enhanced Physiological Tremor

Triggers include:

• Stress or anxiety

• Caffeine

• Thyroid overactivity

• Low blood sugar

Tremor is fast and fine; reducing triggers helps.

5. Drug-Induced Tremor

Caused by medications such as:

• Lithium

• Valproate

• Antidepressants

• Bronchodilators

• Stimulants

6. Neuropathic Tremor

Seen in peripheral neuropathy; often accompanied by numbness, tingling, or weakness.

7. Psychogenic (Functional) Tremor

• Sudden onset

• Variable frequency

• Improves with distraction

Risk Factors for Essential Tremor

1. Genetics

A strong familial link; children have a 50% chance of inheriting ET from an affected parent.

2. Age

Most commonly diagnosed after age 40, but may appear earlier.

3. Medical Conditions

Thyroid disorders, diabetes, kidney disease, and chronic anxiety may worsen tremor.

Treatment Options for Essential Tremor

While there is no cure, effective treatments can significantly reduce symptoms.

1. Medications

• Beta-blockers (propranolol)

• Antiseizure medications (primidone, topiramate)

• Anti-anxiety medications (short-term use)

• Gabapentin (select cases)

Medication choice is individualized based on severity and patient profile.

2. Physical & Occupational Therapy

Helps improve motor control and daily functioning. Adaptive tools may include:

• Weighted utensils

• Special writing aids

• Tremor-canceling devices

3. Lifestyle Modifications

• Reduce caffeine intake

• Practice yoga, meditation, and relaxation techniques

• Maintain adequate sleep

• Engage in regular physical activity

• Avoid known triggers

4. Advanced Treatments

Deep Brain Stimulation (DBS)

A highly effective surgical option for severe, medication-resistant tremors.

MRI-Guided Focused Ultrasound (MRgFUS)

A non-invasive technique available in select neurosurgical centers.

Both target the thalamus, a key tremor-control region.

Living with Essential Tremor

Many individuals with essential tremor lead active and fulfilling lives with proper support. Tips include:

• Using adaptive devices for daily tasks

• Maintaining overall wellness through physical activity

• Reducing stress

• Joining support groups

• Regular follow-up with a neurologist

⚠️ Disclaimer

🔔 This article is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your doctor or neurologist for personalised medical guidance.

​👨‍⚕️About Author​

Dr. Haseeb Hassan | Senior Neurologist, Kolkata (20+ Years Exp)🧠 Dedicated to advanced neurological care and personalized patient recovery. 

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