A benign essential tremor is a type of tremor that occurs when a person is trying to complete simple tasks. When trying to complete these tasks their hands tend to shake uncontrollably making it quite difficult to grasp objects, write legibly, tie their shoes or shave without cutting themselves. This type of tremor can affect just about any part of the body, but the hands seem to be the most commonly affected. As the patient gets older they may begin to experience this tremor in their voice, head or arms.
The symptoms of this type of tremor tend to begin gradually and get worse as the patient gets older. It tends to occur in the hands first, sometimes only affecting one hand when it begins. This type of tremor seems to get worse with movement. It is also often aggravated by fatigue, emotional stress, temperature extremes and caffeine. When this type of tremor affects the head it often causes the patients head to make “yes” or “no” motions.
Causes and Risk Factors
Benign essential tremors tend to affect those over sixty-five years of age and it is estimated that approximately fourteen percent of people in this age group experience this condition. However, this condition can affect people of all ages. The only known risk factor for this condition is advanced age. Approximately fifty percent of patients with this condition have it due to a genetic mutation. When a genetic mutation is the cause it is referred to as a familial tremor. When a genetic mutation is not present the cause is unknown.
There is no single test that can diagnose this condition. Doctors will often perform tests to rule out other conditions to make a diagnosis. The first test that is often performed is a neurological exam. During this exam the doctor will check the patient’s muscle tone and strength, tendon reflexes, coordination and posture, and ability to feel specific sensations. Next, the doctor may collect urine and blood samples to test for drug side effects and thyroid disease. To test the tremor itself the doctor may have the patient take a performance test. This test consists of the patient drawing a spiral, drinking from a glass, writing a few sentences and holding their arms outstretched.
If the patient is only experiencing minor symptoms treatment may not be necessary. If treatment is necessary, medications and therapy are most common. Some patients benefit from a beta-blocker because these drugs, though most often used for high blood pressure, can help to alleviate tremors for some patients. Anti-seizure medications may be prescribed to those who do not notice any relief from beta-blockers. If a patient’s tremors are magnified by anxiety or tension the doctor may prescribe tranquilizers. Botox may also be beneficial to patients who do not respond to medication because it can help to alleviate tremors for up to three months. Botox is most beneficial in treating voice and head tremors and isn’t often used for hand tremors because it may weaken the fingers.
Therapy can be used to decrease the amount a tremors a patient experiences as well as improve the patient’s muscle control and coordination. The most beneficial form of therapy is occupational therapy. This form of therapy can help to reduce how these tremors affect how the patient performs everyday tasks. Patients can use devices such as wrist weights, wider pens and pencils, and heavier glasses, plates and utensils to help reduce how their tremors affect them.
Surgery can also be done, but this option is only recommended for patients with severely disabling benign essential tremors that do not respond to other therapy methods and have a significant negative impact on the patient’s ability to perform daily tasks. The most common surgical procedure is deep brain stimulation. During this procedure a thin, long electrical probe will be inserted into the part of the patient’s brain that causes their tremors. This part of the brain is called the thalamus. Next, a device similar to a pacemaker is inserted. The device will interrupt tremor-causing signals from the thalamus, but transmitting painless electrical pulses.
Mayo Clinic. (2009). Benign Essential Tremor. Retrieved on September 27, 2009 from Website: https://www.mayoclinic.com/health/essential-tremor/DS00367