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What Causes Essential Tremor?

The exact cause of essential tremor is unknown. It does not come from just one part of the brain, but from poor communication across a loop of brain regions known as the cerebello-thalamo-cortical circuit. Both the cerebellum and the thalamus play major, connected roles in this disease.

Several genes, as well as environmental factors, likely help determine an individual's risk of developing this complex condition. The specific changes in the nervous system that account for the signs and symptoms of essential tremor are unknown.

The Role of the Cerebellum

The Pacemaker of Shaking: Most new research points to the cerebellum as the primary generator of the abnormal electrical rhythms that start the tremor.
Coordination Center: The cerebellum normally helps smooth out and coordinate your body's muscle movements.
Cell Changes: Experts believe changes or overactive brain waves in the cerebellar cells disrupt normal control.

The Role of the Thalamus

The Relay Station: The thalamus acts like a signal hub. It takes faulty, overactive tremor signals from the cerebellum and passes them up to the motor cortex.
Treatment Target: Because the thalamus forwards these bad signals, doctors target a specific part of it (the ventral intermediate nucleus) with treatments like Deep Brain Stimulation or focused ultrasound to block the shaking.

The cerebellum likely creates the abnormal rhythm, while the thalamus relays and amplifies that rhythm to the rest of the body.

Genetic and Family Factors

Inherited genes: About 50% to 70% of cases run in families, often called familial tremor.
Family link: If a parent has the gene, a child has a 50% chance of inheriting ET.

Brain and Nerve Factors

Brain communication: Parts of the brain like the cerebellum and thalamus send irregular signals to the muscles.
Chemical imbalance: Changes in brain chemicals, such as GABA, may affect how nerve cells, such as Purkinje cells, are lost or damaged,

Things That Make It Worse

Stress and anxiety: Strong emotions can make shaking worse.
Caffeine: Too much coffee or energy drinks can trigger or increase a tremor.
Tiredness: Lack of sleep makes symptoms more obvious.
Certain medicines: Stimulants or asthma drugs can make a tremor stronger.

What is Tremor?

Tremor is an unintentional, somewhat rhythmic, muscle movement characterized by to-and-fro (oscillatory) movements of one or more parts of the body. Essential tremor (previously called benign essential tremor) is the most common form of abnormal tremor.

Although it may be mild and nonprogressive in some people, in others the tremor is slowly progressive, starting on one side of the body but eventually affecting both sides.

Hand tremor is most common, but the head, arms, voice, tongue, legs, and trunk may also be involved. Hand tremor may cause problems with purposeful movements such as eating, writing, sewing, or shaving. Head tremor may be seen as a "yes-yes" or "no-no" motion.

Onset is most common after age 40, although symptoms can appear at any age.

Can My Tremors Be Another Disease?

Some other brain diseases and movement disorders share symptoms with Essential Tremor disease. While each condition is unique, they also share treatment options, and research into one may help understand and treat others.

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How to Diagnose Essential Tremor?

Diagnosing Essential Tremor involves reviewing your medical history, family history and symptoms and conducting a physical examination.

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My Hand is Shaking. Will it get worse?

The disease typically begins in one hand or arm. Over time, the other hand or arm may also be affected, and it can spread to involve the legs, head, and voice.

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Is ET a neurodegenerative Disease?

Essential tremor (ET) belongs to a group of diseases known as neurodegenerative disorders or, more specifically, movement disorders, though it was once considered a more isolated condition.

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Can My Children Inherit Essential Tremor?

About 50 percent of essential tremor cases are thought to be caused by a genetic risk factor.

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Can you have a gait disorder with ET?

Gait disturbances of patients with essential tremor (ET) have been described anecdotally, but have never been investigated quantitatively.

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The medical information contained is for general information purposes only. It is crucial that care and treatment decisions related to Essential Tremor disease and any other medical condition be made in consultation with a physician or other qualified medical professional.