We hear countless stories about people who had hand tremors since childhood or their teens, but were diagnosed with essential tremor (ET) later in adulthood. We hear fewer stories—but still a substantial number—of people who developed hand tremors between ages 40-60 who were initially misdiagnosed as having Parkinson’s disease; later it turned out to be ET or a less common condition.

Types of tremors

Whether we realize it or not, all of us have tremors. However, they are so subtle that most of us can’t see or feel them, and they are called physiologic tremors because it’s in the nature of our bodies to have these very slight vibratory effects. It’s only when “the shakes” become evident that problems begin to arise. The hands are generally the most affected body part, and hand tremors are classified according to three types based on how they behave:

1. Postural tremors happen you raise your arms to shoulder height and stretch them in front of you or out to the sides. To keep them there, your muscles must work against gravity, and your hands begin to tremble even though you’re not using them for something else.
2. Task-specific tremors happen when you’re using your hands and arms to perform an activity such as drying dishes or pushing a child in a swing.
3. Intention tremors happen when you’re focusing hand and arm movement on a target, such as placing a screwdriver in a screw or engaging a zipper to pull it up.

Tremors can also occur when the hands are at rest. It was once believed that resting tremors were more characteristic of Parkinson’s disease (or other problems) than ET, we now know that countless people with ET experience resting tremors of the hands or other body part, especially as ET progresses.

Numerous conditions with hand tremor symptoms

Essential tremor is not the only source of symptomatic hand tremors. Here are several other conditions or syndromes that manifest with hand tremors:

• Functional tremor occurs when the nervous system is not working properly but no other cause can be found.
• Enhanced physiologic tremor is simply an exaggeration of the undetectable natural tremors that occur all the time. It can be brought on by stress, fatigue, too much caffeine, etc.
• Tremor following a stroke is not uncommon, depending on the brain area that was damaged by a blockage of blood or a “bleed” in the brain. The person may experience subsequent resting or action tremors, either occasionally or more often.
• Medication-related tremor may be brought on by certain prescription drugs. If tremors appear after starting a new medication, speak to your doctor immediately.
• Withdrawal-induced tremors can happen during periods of withdrawal from alcohol or other addictive substance.
• Parkinson’s disease, multiple sclerosis or other degenerative neurological conditions can be accompanied by tremors.

Importance of correct diagnosis

Seeing the various conditions that can lead to tremors of the hands or other parts of the body, it is clear that obtaining a correct diagnosis is the key to establishing a treatment plan. Getting a diagnosis can be discouraging especially if many doctor appointments, tests, and second opinions are involved.

Even more demoralizing is the search for a treatment. In the case of ET, the first recommendation is almost universally pharmaceuticals such as propranolol or primidone—but only about half of those who begin medication use find that this approach works (with or without side effects). Some people find that medication alternatives like CBD oil, or lifestyle changes such as meditation, are helpful. Others turn to physical/occupational therapy or stress management for ways to manage better with tremors.

A lasting solution for ET hand tremors

Sperling Neurosurgery Associates offers Neuravive®, a revolutionary noninvasive application of Focused Ultrasound for the treatment of ET hand tremors that don’t respond to medication. Under the guidance of real-time MRI, over a thousand beams of ultrasound are aimed at a tiny area of the brain’s thalamus. The intense heat that is generated when the beams meet is able to deaden the “control center” that forwards abnormal brain signals ultimately to hand muscles.

For more information, or to request a consultation, visit our website.