Often misunderstood or mislabelled as just a physical quiver or shake, Essential Tremor is actually a neurological disorder. It is characterized by involuntary rhythmic shaking or trembling of certain parts of the body. Although it is largely a benign condition, its impact on an individual’s daily life is grossly underestimated.
Through this blog, we will shed light on the complexities of Essential Tremor, while also exploring its causes, symptoms, and various management options. This blog also highlights the importance of exercise in managing this condition.
What is Essential Tremor?
Essential Tremor (ET) is a nervous or neurological condition that causes rhythmic, involuntary shaking of different body parts. It most commonly impacts the head, arms, hands, and in many cases, even the voice.
Essential Tremor manifests as rhythmic, involuntary shaking of certain body parts, commonly affecting the hands, arms, head, voice box (larynx), tongue, chin, and sometimes the voice. The lower body is hardly ever involved or impacted by this condition.
ET is the most common trembling disorder. All of us have a small degree of tremor, albeit they are not felt or seen. But as we age, the degree and severity of the tremor can increase. Experts believe that tremor that typically manifests after 65 years of age should be classified as age-related tremor, while the tremor that starts earlier is ET.
Causes of Essential Tremor
Although the exact cause of ET remains unknown, research suggests a strong genetic component. Typically, those with a family history of tremors are at greater risk of developing ET.
Additionally, genetic mutations have also been linked to disruptive functioning of the cerebellum, the brain’s movement center.
After a genetic predisposition, the second most common associated risk factor or cause of ET is age. Studies have shown that ET is common in people who are above 40 years of age.
Besides the above, environmental factors, particularly exposure to certain toxins can increase the risk of developing ET.
Symptoms of Essential Tremor
While the body part(s) that are impacted by ET may differ from person to person, the nature of the tremors are essentially common to all. Understanding the specific symptoms of Essential Tremor is critical for an accurate diagnosis as well as timely intervention. The following are the most common symptoms of ET:
- Rhythmic shaking – Noticeable during voluntary movements, such as writing, holding a cup, etc.
- Worsening tremors – Certain purposeful movements, such as drinking, eating, etc. may worsen tremors
- Shaky or quivering voice
- Uncontrollable nodding or shaking of head
- Caffeine, certain types of medications may trigger tremors
- Alcohol, especially wine, may soothe the tremor
- Dissimilar rhythmic shaking on both sides of the body
- In some cases, tremors in legs and feet (very rare)
Essential Tremor Diagnosis
In order to conclusively determine/arrive at an ET diagnosis, there are a combination of tests that are carried out based on the symptoms of the individual. These tests include:
- Medical history
- Family history
- Neurological examination – check for tendon reflexes, posture, gait, coordination, muscle strength and tone, ability to respond to certain stimulus
- Laboratory tests – check for thyroid levels, side-effects of medications, metabolic disorders, etc.
- Performance tests – check for simple fine motor skills (holding a glass, writing, drawing a spiral, holding arms outstretched)
These tests can also help provide a differential diagnosis, especially since Essential Tremor and Parkinson’s Tremor share many commonalities.
You can read more about the differences between Essential Tremor and Parkinson’s Tremor here.
Managing Essential Tremor
From medications to surgical interventions, the treatment for Essential Tremor typically involves a multidimensional approach that is customized to suit the individual’s symptoms. Below are some of the most commonly prescribed management strategies for ET:
Surgical Interventions
Deep Brain Stimulation (DBS)
This approach involves implanting electrodes into certain specific areas of the brain. These electrodes are connected to a stimulator device, like a pacemaker.
Focused Ultrasound Thalamotomy
This is a non-invasive procedure that uses ultrasound waves to create a lesion in the thalamus (the tremor control center of the brain).
Non-Surgical Interventions
Stem Cell Therapy
The anti-inflammatory and immunomodulatory properties of mesenchymal stem cells (MSCs) have allowed stem cell therapy to offer more than just a ray of hope to those living with challenging neurological conditions like Essential Tremor. MSCs offer neuroprotection to existing neurons, and prevent further damage that could potentially slow down disease progression. Simultaneously, MSCs may also influence the brain’s neural circuits and effectively correct any abnormal signalling pathways. They may also be able to integrate with existing neural networks, thus helping to restore motor function and control.
Medications
Anticonvulsant medications and beta blockers are prescribed to regulate nerve cell activity. This can in turn reduce the intensity of tremors. In cases where medications provide limited or no relief, DBS is recommended.
Botox Injections
Specifically for patients with localized tremors, botulinum toxin is injected into specific muscles to provide temporary relief.
Exercise for Essential Tremor
Often underestimated, exercise plays a crucial role in managing ET. At Plexus, we offer targeted and customized physiotherapy programs that provide relief by focusing on the following:
Improve Coordination
The patient’s exercise regimen will be tailored to enhance motor skills and overall coordination. It will also reduce the impact of tremors and improve everyday functioning.
Enhanced Muscle Control
Specific exercises are designed to better muscle control, thereby reducing the intensity of tremors while performing specific tasks.
Better Stability
Core muscle strengthening can greatly improve balance and coordination. This in turn can increase stability, as well as improve posture and movement.
Stress Mitigation
Stress and anxiety have been known to trigger ET symptoms. Exercise is a natural stress reliever. It supports emotional well-being and reduces the severity of tremors.
Plexus Recommends
Here’s what our team of expert physiotherapists and movement therapists recommend:
Tai Chi and Yoga
Incorporating mindfulness, gentle movements, breath control, Tai Chi and Yoga are great for Essential Tremor management. Tai Chi helps with motor control and balance, and promotes mind-body connection. It is a great form of mind-body practice for those who are looking for a non-pharmacological, yet holistic approach.
Yoga improves flexibility and strength, promotes relaxation, reduces stress and anxiety, and emphasises on the importance of mindfulness and being present (in the moment).
Both Tai Chi and Yoga can be adapted to suit the individual’s lifestyle and fitness levels.
Movement Therapy
Comprising physiotherapy, occupational therapy, dance therapy, gentle and focused movements (Feldenkrais Method), and posture and movement awareness (Alexander Technique), Movement Therapy focuses on body awareness and movement. It greatly benefits the individual’s physical and emotional well-being by offering better motor control and coordination, along with a much improved quality of life.
Since Tai Chi and Yoga involve breathing techniques, body awareness, and mindful movements, at Plexus they are also a distinct part of our Movement Therapy program.
FAQs
Can essential tremors be cured?
The symptoms Essential Tremor can be managed through various treatments, including medications, surgical interventions, and lifestyle changes (exercise and physical activity)
What foods reduce tremors?
A balanced diet rich in antioxidants, vitamins, and minerals is known to support overall health. Research indicates that omega-3 fatty acids found in fish, fruits, and vegetables can provide relief from symptoms. Please be sure to discuss any dietary modifications with your doctor.
Does essential tremor affect the brain?
Yes, Essential Tremor primarily impacts the cerebellum, a region of the brain responsible for motor control.
Do people with essential tremor live longer?
Essential Tremor is not a life-threatening condition. Individuals with ET typically have a normal life expectancy. However, it affects the quality of life.
Is essential tremor harmful?
Although not harmful to overall health, Essential Tremor can hinder everyday functionality. This in turn can have adverse effects on the individual’s mental and emotional well-being.
