Essential Tremor

Before your first visit, we begin your evaluation by sending you a few surveys to complete. We’ll ask you about things ranging from your mood and daily activities to your physical symptoms. The unintentional shaking or tremors that go with essential tremor can happen in various parts of your body. You might feel shaking in your:

• Arms.
• Hands.
• Head (like a nodding yes or no motion).
• Legs.
• Torso (chest, abdomen, pelvis and back).
• Mouth and throat, which affect your voice.

Your answers on the survey help your provider understand your symptoms. This allows your time in the office to be as helpful as possible.

During your office visit, you will talk with a movement disorders specialist about the issues you’ve been experiencing. You’ll discuss your medical and family history, because essential tremor may run in families. Most importantly, we focus on understanding your individual history and how your symptoms affect your ability to do the activities you enjoy.

We will also perform a physical evaluation, asking you to do various tasks like pouring water, writing and walking. This evaluation helps us identify when tremors happen so we can rule out other conditions that cause tremor, such as Parkinson's disease.

If we diagnose your symptoms as essential tremor, we’ll discuss the various treatment options available we offer. Following your appointment, you may get additional testing done to provide your doctor with more information about your health and rule out other conditions. Tests you may need can include:

• Blood or urine tests that check for other causes of tremor, such as thyroid problems.
• Magnetic resonance imaging (MRI) that looks at the structures in your brain, to rule out other causes of tremor.

Although essential tremor has no cure, treatment can help reduce how much it affects your life. The right treatment for you depends on how much the symptoms interfere with your ability to do your daily activities. If your health and symptoms change at any point, then your treatment can change, too. Our treatment options include:

Medication for tremor

The exact cause of essential tremor is still unknown, but medications can help lessen the symptoms. They work by changing brain activity, which reduces the tremor.

Medication can cause unwanted side effects, so we try different types and amounts to find what works best for you. Doctors most commonly prescribe:

• Blood pressure medications (beta blockers), such as propranolol.
• Seizure medications, such as primidone.
• Botulinum toxin (Botox®) injections, which relax your muscles to reduce tremor.

Therapies for essential tremor

Depending on your symptoms and how they affect your daily activities, we may recommend one or a combination of therapies. These may include:

• Occupational therapy: Adaptive devices, such as weighted utensils and flexible bowls and cups that offset tremor, can help with everyday activities. You can also try wrist weights. Wearing a light weight around your wrist can offset hand tremors and make it feel easier to do daily talks. With occupational therapy, our therapists work with you to try these devices and techniques to see if they’re helpful.
• Speech and voice therapy: You can see a speech-language pathologist, respiratory therapist or a voice coach to help with voice tremors. Depending on how essential tremor affects your voice, speech therapy or voice therapy may work better for you.
• Physical therapy: As essential tremor worsens over time, it may affect your strength, balance and coordination. Our therapists guide you through physical therapy exercises to improve your ability to walk and move.

Deep brain stimulation and focused ultrasound for essential tremor

If you have a severe tremor or find that medications no longer work well, surgery may be an option for you. You and your neurologist will have a detailed discussion about your hopes for surgery, the types of surgery and how they work.

You'll then meet with our imaging specialists, neurosurgeons, neuropsychologists and psychologists. The team carefully evaluates you to understand how surgery can help you and which type may be right for you, based on your mental and physical health.

You and your doctor will discuss the results of the evaluation and go over your options, which may include:

• Deep brain stimulation (DBS): DBS systems deliver mild electrical pulses to your brain to reduce your tremor. We use the latest DBS technology, which allows for advanced customization. We can also coordinate travel to main campus for surgical care, followed by ongoing monitoring of the implant by your neurologist at another of our locations close to your home.
• MR-guided focused ultrasound: This surgery uses ultrasound (sound waves) to treat the area of the brain that contributes to your tremor. Heat from the ultrasound targets a tiny area of brain tissue without damaging surrounding healthy tissue.

Mental Health Services for Movement Disorders

Essential tremor can be a devastating diagnosis, leading to depression and social isolation. We know that emotional factors, like stress, anger or anxiety, can worsen tremor, too.

Taking the Next Step

At Cleveland Clinic, we have a team of psychologists dedicated to working with people who have a movement disorder . Our specialists understand the challenges of essential tremor and are there to help guide you through it. If you’re experiencing any difficulties due to essential tremor, you can meet with a psychologist virtually or in person.