International Parkinson and Movement Disorder Society



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International Parkinson and Movement Disorder Society  

555 East Well Street, Suite 1100 • Milwaukee, WI 53202 • +1 414-276-2145 • www.movementdisorders.org

MDS-0416-667

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Essential tremor (ET) is the most common movement disorder. 



It is also known as benign essential tremor, familial tremor, or 

hereditary tremor. Patients with ET may experience 

uncontrollable shaking (tremor) in the hands, head, voice, or 

other body parts. The condition usually begins as an adult and 

may gradually become worse with age. Tremor is typically most 

noticeable when holding the hands outstretched or making fine 

hand movements, such as holding a cup, using a spoon, or 

writing. The tremor usually stops if the hands/arms are 

completely relaxed, such as when resting in the lap. Stress often 

makes the tremor temporarily worse. 

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The cause of ET is unknown, but more than half of patients have 

another family member with tremor. Researchers have not found 

the gene(s) that cause ET. For patients with a family history of 

ET, symptoms tend to begin at an earlier age. Researchers think 

ET develops in the brain, but patients’ brain scans appear normal. 

There is no diagnostic test for ET. However, your doctor may test 

your blood for other conditions such as thyroid disease that could 

worsen the tremor. Some medications may also worsen tremor. 

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There is effective treatment to lessen the tremor, but there is no 



cure. Using weighted cups, utensils, and even wearing small 

wrist weights can help some patients. Some patients may benefit 

from medications. Medications are usually given on a trial-and-

error basis. Some work better than others depending on the 

individual patient. Medications that may help include: 

•   Beta-blockers, such as propranolol

  Anti-seizure medications, such as primidone, gabapentin, 

topiramate, and clonazepam

Your doctor may suggest cutting back on caffeine, other stimulants, 

and some tremor-producing medications. Patients with certain 

types of tremor may benefit from botulinum toxin injections. 

Botulinum toxin is injected into the muscles that cause the tremor, 

temporarily weakening the muscle to reduce the tremor. These 

injections must be repeated two to four times per year and are most 

effective for patients with head or voice tremor.

Although medical treatment may help some patients with tremor, 

and should be tried first, those with severe tremor may consider a 

surgical procedure. Your neurologist can advise you on the most 

appropriate treatment options for your condition. There is more 

than one type of surgery for ET, they are:

•   Thalamotomy: a type of brain surgery where one part of the 

brain, the thalamus, is destroyed

•   Deep Brain Stimulation (DBS): another type of thalamus 

surgery where a thin wire (also called an electrode) is placed 

into the thalamus and connected to a pacemaker-like device 

under the skin in the chest

•   Other surgical procedures

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No. ET is about 10 times more common than Parkinson’s disease 



(PD). Unlike ET, the hand tremor of PD is most obvious when a 

patient’s hands are relaxed and not when they are being used for 

activities. Other signs of PD, but not ET, include slowness of 

movement, walking difficulties, and other exam findings. 

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ET does not shorten your life expectancy. Tremor may increase 

over time, but the change is usually slow, typically over many 

years. Eventually some patients may experience a degree of 

disability, such as difficulty writing, eating, and drinking or even 

social embarrassment. Mild tremor does not typically require 

treatment, and early treatment does not stop or slow the 

symptoms’ natural changes. Only consider starting medication 

treatment when the tremor affects your daily activities or causes 

problems for you.



Essential Tremor:  

Essential Facts for Patients

Essential Tremor:  

Essential Facts for Patients 

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