What is Physiologic Tremor?

Physiologic tremor is defined as a normal action, present in both children and adults. Usually, the oscillating movement of any body part is hardly noticeable to the naked eye. Physiologic tremor is observable when enhanced by strenuous activity, exhaustion, stress, excitement or fear.

Example of Enhanced Physiologic Tremor (EPT)

Tyler Hamilton’s hands trembled and shook after completing Stage 5 of the 2003 Tour de France. He needed both hands to lift a beverage to his lips. The American cyclist experienced EPT from riding 123 miles over hills. After fifteen minutes of rest, the twitching in his hands slowly dissipated, and Tyler Hamilton gingerly signed autographs for his fans.

Who does Essential Tremor Affect?

Essential tremor may affect up to six percent of the general, multi-racial population. More than ten million Americans live with essential tremor, ten times the number of  people afflicted with Parkinson’s Disease.

What is Essential Tremor?

Unlike EPT, essential tremor is a repetitive involuntary movement, which causes parts of the body (hands, arms, head, voice) to tremor, even in the absence of the physiological activity that enhanced cyclist’s Tyler Hamilton’s hands to tremble. Essential tremor can appear in more than one body part at the same time, marked by bilateral symmetry.

Essential tremor is a chronic, progressive neurological disorder that can occur at any age, including birth. Essential tremor does not discriminate. Males and females are affected equally.

At present, there is no known cure for essential tremor. Generally, treatment for essential tremor include: medications (beta-blockers, anticonvulsants and benzodiazepines), botulinum toxin injections (Botox), Deep Brain Stimulation surgery (DBS) and Gamma Knife thalamotomy. Therapy varies with each individual.

Effectiveness of therapy can be less than optimal. Essential tremor can worsen, leaving people disabled, unable to perform life’s daily activities. Essential tremor can affect employment.

Even though the cause of essential tremor is not clearly defined, the identification of gene loci mapped to chromosomes in studies with a few families, exemplify that genetics may be considered in establishing the cause of essential tremor. Admittedly, more studies are needed to substantiate possible connections to the cause.

Is There a Treatment Guideline for Essential Tremor?

Evidence-based Guideline Update: Treatment of Essential Tremor
The American Academy of Neurology (AAN) invited esteemed clinicians to review published essential tremor clinical trials between 2004 and April 20010. The 2011 conclusions and recommendations by these neurologists experienced with essential tremor, are an update of the 2005 AAN Practice Parameter: Therapies for essential tremor. The information compiled is primarily for limb tremor with the exception of Propranolol for head tremor.

Is Essential Tremor Manageable?

Essential tremor: Choosing the right management plan for your patient
The Cleveland Clinic Journal of Medicine article establishes the fact that essential tremor must first be accurately diagnosed before it can be effectively managed by drugs. However, the authors of the article recognize that patients with “severe, resistant, or atypical” essential tremor may need to be managed with alternative options such as botulinum toxin or deep brain stimulation surgery. Though the article is written as a CME activity, the article’s key points are user-friendly; especially, for the patient correctly diagnosed with essential tremor, or for the patient that is in need of a definitive diagnosis to rule out another type of tremor. Tremor Action Network highly recommends this article to share with the treating physician that is managing the treatment plan for essential tremor. First, second and third-line anti-tremor drug agents are outlined in detail, including but not limited to effectiveness and contraindications. The authors address the degree of success in treating essential tremor with botulinum toxin and deep brain stimulation. Guidelines for caffeine intake, sleep and stress are given as choices of treatment. So is occupational therapy.

“A disease known is half-cured.”
Thomas Fuller
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