Diagnosing Essential Tremor
Essential tremor disorder is a neurological condition that causes your hands to shake rhythmically. The head, trunk and voice might also be involved, but hand shaking is most prominent. The cause is not known, but it is often passed down from a parent to a child.
Essential tremor is sometimes confused with other types of tremor, so getting the right diagnosis is important.
Tremors tend to be worse during movement than when at rest. The tremors can be disabling and can slowly worsen over time.
Some things might make tremors worse, and avoiding them may be helpful. Medicines can also help control or limit tremors in some people. Severe tremors can sometimes be treated with surgery.
Essential tremor is sometimes confused with other types of tremor, so getting the right diagnosis is important.
Tremors tend to be worse during movement than when at rest. The tremors can be disabling and can slowly worsen over time.
Some things might make tremors worse, and avoiding them may be helpful. Medicines can also help control or limit tremors in some people. Severe tremors can sometimes be treated with surgery.
Diagnosing Essential Tremor involves reviewing your medical history, family history and symptoms and conducting a physical examination.
Doctors don’t understand the true cause of essential tremor, but it’s thought that the unusual electrical brain activity that causes it is processed through the thalamus. The thalamus is a structure deep in the brain that coordinates and controls muscle activity.
The appearance of your tremor, in the setting of a comprehensive neurological examination by an experienced clinician, can result in diagnosis of essential tremor.
Genes cause ET in half of all people with the condition. Someone who has ET will have up to a 50% chance of passing down the responsible gene to their child, but the child may never have symptoms. Although ET is more common in older people -- and symptoms become more serious with age -- it is not a part of the natural aging process.
There is currently no diagnostic test available to identify essential tremor. The diagnosis is usually based upon the symptoms and clinical exam, as well as the absence of other findings that could provide an alternative explanation for the tremors. To do this, your health care provider may suggest the following tests:
The main symptoms of essential tremor include:
- Shaking for brief periods of time that you can’t control
- Shaking voice
- Nodding head
- Tremors that get worse during emotional stress
- Tremors that get worse when you move on purpose
- Tremors that lessen with rest
- Balance problems (in rare cases)
Many other factors or diseases can also cause tremors, including Parkinson's disease, multiple sclerosis, fatigue after exercise, extreme emotional distress, brain tumors, some prescription drugs, metabolic problems, and alcohol or drug withdrawal.
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
- Thyroid disease
- Metabolic problems
- Drug side effects
- Levels of chemicals that may cause tremor
- Drink from a glass
- Hold your arms outstretched
- Write
- Draw a spiral
What tests may be done to diagnose essential tremor? When your healthcare provider suspects essential tremor, they may need to rule out other conditions. The most common and likely tests that help rule out other conditions include:
- Blood tests (these can help rule out conditions that look like essential tremor, especially thyroid conditions, Wilson’s disease and toxic exposure to metals like lead or manganese).
- Computerized tomography (CT) scan.
- Genetic testing.
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) scan.
Essential tremor can be linked to other illnesses. Other movement disorders, such as Parkinson's disease, have been associated with ET. Some reports have linked ET with migraine headaches.
There is no cure for essential tremor.
Beta-adrenergic blockers (principally propranolol) and primidone are the first-line treatment for essential tremor
https://www.mayoclinic.org/diseases-conditions/essential-tremor/diagnosis-treatment/drc-20350539
https://www.webmd.com/brain/essential-tremor-basics
https://www.webmd.com/brain/essential-tremor-basics
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