How is Essential Tremor Diagnosed?

Essential tremor (ET), also known as familial tremor, affects an estimated 10 million people in the United States and is one of the most common neurological disorders¹. Symptoms include uncontrolled shaking in the hands and arms.

There are, however, many disorders that have symptoms of tremors or shaking. While the tremors can seem similar, the underlying cause often requires different treatment options, making a proper diagnosis critical to ensure the condition is addressed for quality care.

Symptoms of Essential Tremor

Essential tremor is most commonly found in older adults and is defined by uncontrolled and unwanted shaking. The typical symptoms of essential tremor include:

• Tremors often more pronounced on one side of the body
• Tremors involving the hands and arms, and less commonly the head, trunk, or legs
• Difficulty with tasks involving the hands, such as writing or using tools
• Difficulty walking or balance problems

At first glance, essential tremor symptoms can seem similar to the symptoms of Parkinson’s disease. A key difference, however, is when tremors occur: Essential tremors are more pronounced when the hands are actively engaged in a task, while Parkinson’s Disease tremors are more noticeable when the hands are at rest.

Diagnosing Essential Tremor

If you are experiencing tremors consistent with essential tremor symptoms, ask a qualified healthcare professional, such as a neurologist or a movement disorder specialist, to perform a diagnostic examination. There is no single test to positively identify essential tremor. Your healthcare provider will use one or several tests to rule out other conditions or causes of shaking. This is called a differential diagnosis.

More specifically, because essential tremor is a neurological condition, a neurological test may be performed to see how your nervous system is functioning on a holistic level. This test may investigate your ability to feel certain sensations, gait and balance, posture and coordination, and your reflexes.

Your healthcare provider may also ask you to perform specific tasks that people with essential tremor typically find more difficult. These tasks may include drinking from a glass, holding your arms outstretched in front of you, or drawing a spiral pattern.

In addition, laboratory tests may be ordered using samples of your blood and/or urine. These tests are designed to rule out alternative causes like thyroid problems, metabolic issues, or side effects of medications.

Your doctor might also ask about your diet, exercise habits, and levels of stress. High levels of stress, fatigue, and caffeine intake can all cause shaking independent of essential tremor. All of these things can exacerbate symptoms for people living with essential tremor.

When talking to your healthcare team about your experience, it’s important to be as specific as you can about where, when, and how you experience tremors. This will help your doctor better understand your condition and increase the likelihood of a correct diagnosis.

Essential Tremor Treatment Options

Not everyone with essential tremor needs treatment, as many people with mild tremors are able to live normal, day-to-day lives. However, if essential tremor is making daily activities difficult at work or at home, you should discuss treatment options with your healthcare provider.

Typical initial essential tremor treatment includes one of the following medication prescriptions - beta blockers, anti-seizure medications, tranquilizers, or Botox injections². Not every medication is right for everyone, so discuss which ones might be the best fit for you with your doctor.

You may also be referred to either physical or occupational therapy. Physical therapists will focus on helping you improve your muscle strength, control, and coordination, which may help reduce the severity of your tremors. Occupational therapists will help you adapt to living with essential tremor, and can recommend various technological devices which can make daily activities easier.

Sometimes, tremors don’t respond well to medication, making surgical intervention an option. Deep brain stimulation (DBS), a common surgical treatment for essential tremor, involves inserting a probe into the brain that is connected to a pacemaker-like device subcutaneously implanted in the chest. The device then transmits painless electrical signals to the probe in the brain, interrupting signals (while the battery is on) that may be causing tremors.

Focused ultrasound treatment (FUS) is a noninvasive surgical option from Insightec, using sound waves to ablate that same small part of the brain that may be causing tremors to stop them permanently. Focused ultrasound is performed on only one side of the brain at a time, which impacts the opposite side of the body. It is also typically performed as an outpatient procedure, it is safe, and has immediate results, with patients usually able to return home on the same day with a low risk of side effects after essential tremor treatment.

Like all surgical procedures, both deep brain stimulation and focused ultrasound can cause side effects which should be discussed with your healthcare provider.

Augusto Grinspan, MD, Chief Medical Officer

Augusto Grinspan, MD is the Chief Medical Officer of Insightec and leads both Clinical and Medical Affairs. Augusto plays a critical role in executing our clinical and medical affair strategies for the company in both diagnostic and therapeutic applications to develop evidence supporting new products and expanded indications. Augusto has 30+ years of experience in the medical and pharmaceutical industries having worked at Merck KGaA, Teva, Johnson & Johnson, Novartis and Acorda Therapeutics. Augusto completed Medical School in Argentina and specialized in Neurology for a number of years in both Argentina and France. He is based in Miami.