Essential tremor (ET) tends to run in families; if one parent had it, you have a 50% chance of inheriting it, and the likelihood of ET increases with age, though we don’t know why. Its telltale sign—shaking—is usually most noticeable in the hands but can also affect the head, voice, and legs.

For some people, essential tremor can flare up in an anxiety-producing event like public speaking. In these cases, sometimes relaxation techniques can help. (File photo)

Not all shaking is ET. “Tremors can arise from thyroid problems and different medications, including antidepressants. ET is commonly mistaken for Parkinson’s disease, but Parkinson’s tremors happen when you’re at rest. ET is more noticeable when you try to do something, like hold a cup,” says Stanley Fisher, M.D., codirector of the Movement Disorders and Rehabilitation Center at Methodist Neurological Institute in Houston, Tex.

What to do when you shake

“For some people, ET flares up when they’re in social situations, like eating out, or in an anxiety-producing event, like public speaking,” Fisher says. If you only need help getting through such situations, relaxation techniques like deep breathing may help.

When tremors are severe or you find even mild ones too restricting, then medicines might be considered. Propranolol is generally the drug of choice. Some anticonvulsants may be used but tend to be sedating, putting you at risk of falling.

Surgery for ET

When ET gets intolerable, there are surgical options. Julie Pilitsis, M.D., Ph.D., director of functional neurosurgery at University of Massachusetts Memorial Hospital in Worcester, Mass., has been using a procedure called deep brain stimulation to minimize and, in many cases, even shut down essential tremor.

In deep brain stimulation, the brain is mapped through an fMRI to find the area affected by ET. Then a pacemaker-like device is inserted into the chest, which emits electrical charges to an electrode (fine wire) in the brain that controls the tremors. “Since most people don’t have tremors when they sleep, the device is programmed to shut down during your usual sleeping hours,” Pilitsis says. “It’s not a quick procedure. From initial evaluation to postoperative follow-up can take several visits.”

Up to 80% of people experience improvement, often significant, after deep brain stimulation. Many can decrease or even eliminate their medications.

Pilitsis urges people to find out more. “Surgery provides a potentially life-changing benefit to people with ET. I hope that with further education of both patients and referring physicians, more people may be helped,” she says.

Talk not only to your doctor, but seek a neurologist with specific expertise in ET for more information.