Essential Tremor

Essential tremor is a disorder of basal ganglia function and the most common cause of tremor in human (incidence in population is 1%). Its onset is pretty early and most of the patients are young adults. Typical is a positive family history and improvement after alcohol. It is getting worse during some activities of daily life (drinking, writing, eating,...).

Sometimes it can be mistaken for Parkinson´s tremor and, because there is no specific test for the essential tremor, so we have to think about it. It is anticipated that there is a connection between these diseases and people can suffer from both of them simultaneously and their symptoms can overlap. Parkinson´s disease reacts on L-dopa therapy, essential tremor usually not.



Etiology
We are still not sure about the origin of this disease, but evidently there is a association with disorder of basal ganglia and cerebellum.

1) Hereditary form

 * autosomal dominant hereditary of genetic mutation
 * includes more than 50% of all cases

2) Sporadic form

 * there is no genetic mutation, but we are not sure about the cause of this form

Signs of Tremor

 * occurs at rest and it´s twice as fast (8-12 Hz) as in people with Parkinson´s disease
 * mainly affects head or upper limbs
 * usually assymetric
 * improves after consumation of alcohol
 * getting worse during movement, stress and emotions
 * middle-age onset
 * in 50% of cases a positive family history
 * See video.

Therapy
Medication of the first choice are β-sympatholytics (propranolol) and the second on are anti-seizure drugs (primidon). The other option are tranquilizers, for people, whose tremor worsens by anxiety or stress.

There is one more solution for people with essential tremor, which do not answer on medication and has severe course. It´s a deep brain stimulation, although it has many adverse affects and risks.

Related articles

 * Basal ganglia
 * Tremor
 * Parkinson´s disease
 * Deep brain stimulation