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Diagnosing essential tremor involves reviewing your medical history, family history and symptoms and conducting a physical examination.
There are no medical tests to diagnose essential tremor. Diagnosing it is often a matter of ruling out other conditions that could be causing your symptoms. To do this, your doctor may suggest the following tests:
Neurological examination
In a neurological examination, your doctor tests your nervous system functioning, including checking your:
- • Tendon reflexes
- • Muscle strength and tone
- • Ability to feel certain sensations
- • Posture and coordination
- • Gait
Laboratory tests
Your blood and urine may be tested for several factors, including:
- • Thyroid disease
- • Metabolic problems
- • Drug side effects
- • Levels of chemicals that may cause tremor
Performance tests
To evaluate the tremor itself, your doctor may ask you to:
- • Drink from a glass
- • Hold your arms outstretched
- • Write
- • Draw a spiral
If your doctor is still unsure if your tremor is essential tremor or Parkinson's disease, he or she might order a dopamine transporter scan. This scan can help your doctor tell the difference between the two types of tremor.
Treatment
Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your doctor.
Medications
- Beta blockers. Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in some people. Beta blockers may not be an option if you have asthma or certain heart problems. Side effects may include fatigue, lightheadedness or heart problems.
- Anti-seizure medications. Epilepsy drugs, such as primidone (Mysoline), may be effective in people who don't respond to beta blockers. Other medications that might be prescribed include gabapentin (Gralise, Neurontin) and topiramate (Topamax, Qudexy XR). Side effects include drowsiness and nausea, which usually disappear within a short time.
- Tranquilizers. Doctors may use benzodiazepine drugs such as clonazepam (Klonopin) to treat people for whom tension or anxiety worsens tremors. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.
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OnabotulinumtoxinA (Botox) injections. Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.
However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If Botox is used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.
Therapy
Doctors might suggest physical or occupational therapy. Physical therapists can teach you exercises to improve your muscle strength, control and coordination.
Occupational therapists can help you adapt to living with essential tremor. Therapists might suggest adaptive devices to reduce the effect of tremors on your daily activities, including:
- • Heavier glasses and utensils
- • Wrist weights
- • Wider, heavier writing tools, such as wide-grip pens
Surgery
Surgery might be an option if your tremors are severely disabling and you don't respond to medications.
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Deep brain stimulation. This is the most common type of surgery for essential tremor. It's generally the preferred procedure in medical centers with significant experience in performing this surgery. Doctors insert a long, thin electrical probe into the portion of your brain that causes your tremors (thalamus). A wire from the probe runs under your skin to a pacemaker-like device (neurostimulator) implanted in your chest. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.
Side effects of deep brain stimulation can include equipment malfunction; problems with motor control, speech or balance; headaches; and weakness. Side effects often go away after some time or adjustment of the device.
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Focused ultrasound thalamotomy. This noninvasive surgery involves using focused sound waves that travel through the skin and skull. The waves generate heat to destroy brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to target the correct area of the brain and to be sure the sound waves are generating the exact amount of heat needed for the procedure.
Focused ultrasound thalamotomy creates a lesion that can result in permanent changes to brain function. Some people have experienced altered sensation, trouble with walking or difficulty with movement. However, most complications go away on their own or are mild enough that they don't interfere with quality of life.
Lifestyle and home remedies
To reduce or relieve tremors:
- Avoid caffeine. Caffeine and other stimulants can increase tremors.
- Use alcohol sparingly, if at all. Some people notice that their tremors improve slightly after they drink alcohol, but drinking isn't a good solution. Tremors tend to worsen once the effects of alcohol wear off. Also, increasing amounts of alcohol eventually are needed to relieve tremors, which can lead to alcoholism.
- Learn to relax. Stress and anxiety tend to make tremors worse, and being relaxed may improve tremors. Although you can't eliminate all stress from your life, you can change how you react to stressful situations using a range of relaxation techniques, such as massage or meditation.
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Make lifestyle changes. Use the hand less affected by tremor more often. Find ways to avoid writing with the hand affected by tremor, such as using online banking and debit cards instead of writing checks.
Try voice-activated commands on your smartphone and speech-recognition software on your computer.