Learn About Essential Tremor

What is the definition of Essential Tremor?

Essential tremor (ET) is a type of involuntary shaking movement. It has no identified cause. Involuntary means you shake without trying to do so and are not able to stop the shaking at will.

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What are the alternative names for Essential Tremor?

Tremor - essential; Familial tremor; Tremor - familial; Benign essential tremor; Shaking - essential tremor

What are the causes of Essential Tremor?

ET is the most common type of tremor. Everyone has some tremor at times, but the movements are usually so small that they can't be seen. ET affects both men and women. It is most common in people older than 65 years.

The exact cause of ET is unknown. Research suggests that the part of the brain that controls muscle movements does not work correctly in people with ET.

If an ET occurs in more than one member of a family, it is called a familial tremor. This type of ET is passed down through families (inherited). This suggests that genes play a role in its cause.

Familial tremor is usually a dominant trait. This means that you only need to get the gene from one parent to develop the tremor. It often starts in early middle age, but may be seen in people who are older or younger, or even in children.

What are the symptoms of Essential Tremor?

The tremor is more likely to be noticed in the forearm and hands. The arms, head, eyelids, or other muscles may also be affected. The tremor rarely occurs in the legs or feet. A person with ET may have trouble holding or using small objects such as silverware or a pen.

The shaking most often involves small, rapid movements occurring 4 to 12 times a second.

Specific symptoms may include:

  • Head nodding
  • Shaking or quivering sound to the voice if the tremor affects the voice box
  • Problems with writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

  • Occur during movement (action-related tremor) and may be less noticeable with rest
  • Come and go, but often get worse with age
  • Worsen with stress, caffeine, lack of sleep, and certain medicines
  • Not affect both sides of the body the same way
  • Improve slightly by drinking a small amount of alcohol
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What are the current treatments for Essential Tremor?

Treatment may not be needed unless the tremors interfere with your daily activities or cause embarrassment.


For tremors made worse by stress, try techniques that help you relax. For tremors of any cause, avoid caffeine and get enough sleep.

For tremors caused or made worse by a medicine, talk to your provider about stopping the medicine, reducing the dosage, or switching. Do not change or stop any medicine on your own.

Severe tremors make it harder to do daily activities. You may need help with these activities. Things that can help include:

  • Buying clothes with Velcro fasteners, or using button hooks
  • Cooking or eating with utensils that have a larger handle
  • Using straws to drink
  • Wearing slip-on shoes and using shoehorns


Medicines may help relieve symptoms. The most commonly used drugs include:

  • Propranolol, a beta blocker
  • Primidone, a drug used to treat seizures

These drugs can have side effects.

  • Propranolol may cause fatigue, stuffy nose, or slow heartbeat, and it may make asthma worse.
  • Primidone may cause drowsiness, problems concentrating, nausea, and problems with walking, balance, and coordination.

Other medicines that may reduce tremors include:

  • Antiseizure medicines
  • Mild tranquilizers
  • Blood pressure medicines called calcium-channel blockers

Botulinum toxin injections may be tried to reduce tremors.


In severe cases, surgery may be tried. This may include:

  • Focusing high-powered x-rays on a small area of the brain (stereotactic radiosurgery)
  • Implanting a stimulating device in the brain to signal the area that controls movement
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What is the outlook (prognosis) for Essential Tremor?

An ET is not a dangerous problem. But some people find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, writing, eating, or drinking.

What are the possible complications of Essential Tremor?

Sometimes, the tremors affect the vocal cords, which may lead to speech problems.

When should I contact a medical professional for Essential Tremor?

Contact your provider if:

  • You have a new tremor
  • Your tremor makes it hard to perform daily activities
  • You have side effects from the medicines used to treat your tremor
How do I prevent Essential Tremor?

Alcoholic beverages in small quantities may decrease tremors. But alcohol use disorder may develop, especially if you have a family history of such problems.

Central nervous system and peripheral nervous system
What are the latest Essential Tremor Clinical Trials?
Studying the Role of the Basal Ganglia in Motor Symptoms Using Deep Brain Stimulation

Summary: This study will probe the function of collections of neurons deep in the brain termed the basal ganglia It will investigate the role of the basal ganglia in how and why movement is disrupted in conditions like Parkinson's disease, Dystonia and Essential Tremor. Deep brain recording and stimulation will be used to probe the basal ganglia's contribution. Patients with relatively severe movement diso...

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Effectiveness of Telemedicine on Health Outcomes (Clinical, Humanistic, Economic) in the Management of Patients With Functional Motor Disorder: Randomised Controlled Clinical Trial

Summary: Functional motor disorders (FMDs) are a broad spectrum of functional neurological disorders, referring to abnormal movements like dystonia, tremor, and gait/balance disorders. Patients with FMDs experience high degrees of disability and distress equivalent to those suffering from degenerative neurological diseases. Rehabilitation is essential in managing FMDs. However, the current systems of rehab...

What are the Latest Advances for Essential Tremor?
Real-World Evidence of Transcutaneous Afferent Patterned Stimulation for Essential Tremor.
Efficacy and Safety of Electroconvulsive Therapy in Patients With Deep Brain Stimulation: Literature Review, Case Report for Patient With Essential Tremor, and Practical Recommendations.
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Real-World Longitudinal Experience of Botulinum Toxin Therapy for Parkinson and Essential Tremor.
Who are the sources who wrote this article ?

Published Date: April 25, 2022
Published By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Bhatia KP, Bain P, Bajaj N, et al. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33(1):75-87. PMID: 29193359 pubmed.ncbi.nlm.nih.gov/29193359/.

Blomstedt P, Hariz M. Surgical management of tremor. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 109.

Jankovic J. Parkinson disease and other movement disorders. In:  Jankovic J, Maziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 96.

Okun MS, Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 382.