Essential Tremor

Essential tremor is a neurological disorder that causes involuntary and rhythmic shaking, most often in the hands.

What’s in this section?

Signs and Symptoms

Symptoms of essential tremor develop over time and usually begin with the hands. The tremor may include a nodding or shaking head motion. It tends to appear more on one side of the body. It worsens with movement and can be triggered by stress, fatigue, caffeine intake and temperature changes.


Diagnosis of essential tremor starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including a detailed neurological exam, blood and urine tests to rule out other causes, and performance tests to evaluate your tremor. This may include drawing a spiral or holding your arms out in front of you.

Treatment Options

There are different treatment options, depending on the severity of your symptoms:

  • Medication to help reduce or control tremors.
  • Physical or occupational therapy to condition your muscles for control and coordination improvement, and to help you adapt to living with essential tremor.
  • Deep brain stimulation This procedure can be recommended because, over time, medications for treating this disease become less effective. We recommend surgery for select patients to improve their quality of life before it declines significantly. You will have a special MRI of your brain 1-2 weeks before your surgery along with an appointment to make sure you can safely go to sleep with anesthesia for the surgeries.

    Once asleep, you will have two very thin electrodes placed in your brain. There will be a CT scan done before you wake up to confirm the accuracy of the leads, and then your first surgery will finish. You will stay in the hospital one night and go home the next day.

    One week later, you will have outpatient surgery while asleep, in which the generator, also known as “battery,” will be placed below your collar bone (where a pacemaker goes) through two incisions. You will go home the same day, and the battery will be turned on in your neurologist’s office. You should ask your doctor about your specific surgery.
  • Stereotactic ablation The goal of this surgery is to create a “lesion” in the brain with energy in the form of heat (either electricity, laser, radio wave or ultrasound). The surgery can be done with or without a “frame,” which is a device that is fixed onto your head before you obtain an MRI of your brain. This defines the “frame based stereotactic” surgery versus the “frameless stereotactic” surgery.

    In both types of operations, a special high-resolution MRI will be needed shortly before your surgery to help target the exact part of your brain (in millimeters) that needs to be treated. You will be brought into the operating room and typically given conscious sedation with medications given through your IV to make you feel comfortable without going to sleep completely. During the procedure, you may be asked to give feedback on what you are feeling. After the procedure is complete, you will typically spend one night in the hospital and likely go home the next day.

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