Essential Tremor

UT Southwestern Medical Center’s movement disorders specialists have extensive expertise in diagnosing and treating essential tremor – the most common movement disorder – as well as other tremor disorders. We take a multidisciplinary approach to help reduce symptoms and improve patients’ quality of life.

We offer advanced treatment options, including deep brain stimulation (DBS) and MR-guided high-intensity focused ultrasound (MRgHIFU), to help manage tremors in patients who do not respond to medications.

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Why Choose UT Southwestern for Essential Tremor Care?

Essential tremor is a neurological disorder that causes involuntary, rhythmic shaking – most commonly in the hands, though it can affect nearly any part of the body. It is the most common tremor disorder and is also known as benign essential tremor or familial tremor.

Essential tremor can often be confused with Parkinson’s disease due to overlapping symptoms, but it is a distinct condition. Although it is not life-threatening, it can significantly interfere with daily activities such as eating, drinking, and writing, making it hard for people to perform everyday tasks.

UT Southwestern has expertise in diagnosing essential tremor and providing comprehensive, individualized care to treat it. Our Movement Disorders Program is a major regional referral center for disorders such as essential tremor.

Additionally, UT Southwestern researchers are conducting pioneering research to understand and treat essential tremor. Their initiatives include efforts to improve patient outcomes through surgical therapies such as deep brain stimulation and MR-guided focused ultrasound.

What Are the Symptoms of Essential Tremor?

People who have essential tremor experience different degrees, locations, and types of shaking, but many share common symptoms. For example, the tremor:

Often begins in the hands, but may also start in the head or voice
Typically affects both hands, though it may be more pronounced on one side of the body
Is noticeable during voluntary movement (action tremor)
Starts gradually and progresses over time
Can cause a “yes-yes” or “no-no” motion when affecting the head

Certain factors can make these symptoms worse, such as:

Stress
Hunger
Fatigue
Caffeine
Smoking
Extreme temperatures

What Are the Causes of Essential Tremor?

The exact causes of essential tremor are not fully understood, but it’s believed to result from abnormal electrical activity in certain areas of the brain that control movement and coordination. In about half of cases, essential tremor is hereditary, caused by a genetic mutation passed from parent to child.

Although it can occur at any age, essential tremor is most common in people older than 65.

How Is Essential Tremor Diagnosed?

To diagnose essential tremor, we begin with a thorough evaluation, which includes a:

Physical exam
Discussion of personal and family medical history
Discussion of symptoms and risk factors

Additional tests we may recommend include:

Neurological examination: A thorough evaluation of muscle strength, coordination, and other functions of the nervous system
Laboratory tests: Blood work and urinalysis that look for signs of metabolic issues, thyroid disease, or other problems
Performance tests: Activities to measure the tremor itself, such as writing or drawing a spiral

To rule out other causes of the symptoms, we might recommend stopping excessive alcohol consumption, avoiding caffeine, and/or discontinuing or decreasing certain medications.

In some situations, we might order an imaging test called a dopamine transporter scan (DaTscan) to help us determine if a patient has Parkinson’s disease instead of essential tremor.

How Is Essential Tremor Treated?

Some patients manage their tremor without treatment.

When a patient seeks treatment, we often prescribe medications, such as:

Beta blockers: These medications, typically used to treat high blood pressure, can reduce tremors in some people.
Anti-seizure medications: Some epilepsy drugs are effective in people who don’t respond to beta blockers.
Tranquilizers: If a patient’s tremors are triggered by anxiety, we might recommend benzodiazepine drugs.
Botulinum toxin injections: Botulinum toxin can be particularly effective at treating head and voice tremors.

If medications become less effective over time or cause bothersome side effects, we may recommend additional treatment options.

One option is MR-guided high-intensity focused ultrasound (MRgHIFU), an incisionless procedure that uses an ultrasound beam to ablate a precise area of the brain that plays a key role in tremor generation. Our advanced imaging techniques improve targeting precision.

Another option is deep brain stimulation, which involves surgically implanting electrodes in targeted areas of the brain. These electrodes are connected to a pulse generator that delivers electrical stimulation to regulate abnormal brain activity. In most patients, this treatment successfully improves functionality.

What Clinical Trials and Research Opportunities Are Available for Essential Tremor?

UT Southwestern offers patients access to innovations in essential tremor care through clinical trials and clinical research. We evaluate new treatments for effectiveness and often become the first in North Texas to offer them.

Current clinical trials include: