What causes ET?
ET is caused by abnormal communication between certain areas of the brain, including the cerebellum, thalamus and brain stem. In the majority of people with ET, the tremor seems to be inherited as an autosomal dominant trait. In other words, each child of a parent with ET has approximately a 50% chance of inheriting a gene that causes ET. Researchers have already located two genes that predispose to ET and are currently trying to locate others. Not everyone who inherits a gene develops symptoms, and some people have ET and do not have a family history of tremor, possibly suggesting other causes. At this time, no genetic test for ET exists.
How does ET differ from Parkinson's disease?
of the IETF Medical Advisory Board created a simple reference guide
that lists basic distinctions between ET and PD signs and symptoms. Visit www.essentialtremor.org/Free-ET-Publications to download this guide and other helpful materials.
"Not all tremors are ET. More than 20 kinds of tremors exist."
Does ET cause death or shorten life?
ET neither kills nor shortens lifespan. At best ET is a nuisance. At worst ET disables. Most cases of ET fall somewhere in between the two extremes.
At what age does ET start?
Though ET may first appear at any age between childhood and old age, onset is rare before the age of 10. Most commonly, onset is after age 40.
Who is affected by ET?
ET is found in all races and in all parts of the world. No one group of people is more likely to develop ET. Men and women are affected equally.
Does ET worsen with age?
No one can predict how much your tremor will worsen with time. The course of ET is variable and may be progressive over many decades.
How is ET diagnosed?
Doctors who are trained to evaluate tremor can accurately diagnose ET on the basis of the symptoms and a neurological examination. There are no blood, urine or other tests for ET. Before making a diagnosis of ET, your doctor may want to investigate other possible causes of tremor such as thyroid disease, excessive caffeine ingestion or medication side effects. During your physical exam, your doctor will be gathering as much information as possible about your tremor.
Here are some questions you may be asked:
- What body part is affected?
- How long have you had the tremor?
- Did it come on suddenly?
- What makes your tremor worse?
- What makes your tremor better?
- Do you drink many caffeinated or alcoholic drinks?
- Do any family members have tremor?
- Have you ever had a head injury?
- Does alcohol temporarily reduce the tremor?
- Does the tremor worsen when you do certain tasks
or when you're under emotional stress?
- Does the tremor disappear during sleep?
- What medications are you taking? Certain drugs may
cause tremor, so take a list of the medications you are taking
or the actual pill containers themselves to your doctor appointment.
Can a diagnosis of ET be made from looking at a brain scan?
A brain scan is not required to diagnose ET. Your doctor might order a magnetic resonance imaging (MRI) scan or a computerized axial tomography (CAT) scan if there is a suspicion of some other cause of tremor. ET does not have associated abnormality on routine scans.
Are all tremors caused by ET?
Many things cause tremor, and not all tremors are ET. More than 20 kinds of tremors exist. For instance, excessive caffeine, alcohol withdrawal, problems with thyroid or copper metabolism or the use of certain medications may cause tremor. A major difference between ET and other tremor types is that in ET tremor is the only symptom, and muscle tone, strength and balance are not usually affected.
Other conditions causing tremor include:
Enhanced physiologic tremor, Parkinson's disease, Cerebellar tremor, Dystonic tremor, and tremor due to medications.
Because tremor is a feature of so many conditions, ET can be mistaken for something else. Some people have ET and another disorder that causes tremor. Note that many prescriptions and illicit drugs, as well as some herbal remedies, can cause or worsen tremor. Tell your doctor about all the medications you are taking.
What medications help ET?
If you have mild ET, you may not need treatment. There is no evidence that early treatment stops or slows the natural progression of ET symptoms. With adequate knowledge, many people learn ways to live well with ET. If possible, you should be taken off any medications that may be aggravating tremor.
If ET is interfering with your ability to work or perform daily tasks, or you find it socially disabling, you may want to consider available therapies. It is important to have realistic expectations for therapy. At present, there is no cure for ET. For the oral medications, a 50% reduction of tremor severity is considered good. The goals of treatment are to reduce tremor severity, improve ability to function and decrease social handicap.
Achieving these goals can sometimes take time, so be patient. While almost two-thirds of people with ET benefit from medical therapies, your doctor may have to try two or three different medicines before finding the one that works best for you.
The main medications used to treat ET are propranolol (Inderal) and primidone (Mysoline). Both can be quite effective.
Can surgery help ET?
If treatment with medications is not effective and ET is very disabling or is putting your livelihood at risk,
your doctor may suggest a surgical technique, such as thalamotomy or Deep Brain Stimulation (DBS).
Are there helpful alternative therapies for ET?
There is no scientific evidence that alternative therapies are helpful for ET, but any activity that can
reduce stress can be beneficial in coping with tremor. Always talk to your doctor before starting any
new therapies. While some herbs that induce relaxation may be helpful, others, such as ma huang,
can worsen tremor. Many people have tried acupuncture, hypnosis, massage, biofeedback, and meditation
with varying results. Confering with physical and occupational therapists can provide information about
assistive devices as well as suggestions on doing common everyday activities in different ways.
Does pregnancy affect the severity of ET?
Tremor severity may fluctuate during pregnancy and after delivery. You should discuss the use
of ET medications with your physician before getting pregnant, as some medications put the
developing baby at risk.
How does the consumption of alcohol affect ET?
While adults with ET often notice that consumption of alcohol reduces their tremor for one to two hours,
the use of alcohol as a treatment for ET is not recommended. Use of alcohol to reduce tremor should be
discussed with your physician.
How can I minimize the affects of ET on my life?
Become informed about your condition and learn as much as you can about living with ET. Instead
of restricting your life because of what others may think, explain your condition simply and honestly
when you meet new people. If your child has ET, you may want to talk to teachers in person about
the neurological basis for symptoms. Find ways to reduce stress and learn some relaxation techniques.
Avoid things that may worsen tremor, such as caffeine and certain prescription medications. Contact
the IETF for an information packet or information about joining or starting a support group for ET.
How can I get the most out of my doctor's visits?
Work closely with your doctor to find the most effective treatment. Take an active role in your treatment.
Discuss your symptoms and questions with your doctor. The more you know about ET and treatment,
the easier it will be to adapt and minimize the interference with your daily life. It is important to discuss
expectations of treatment results, side effects and other issues such as employment.
How can I learn more about the medications I am taking?
Consumer Reports Best Buy Drugs is a free public education service from the nonprofit Consumers Union, publisher of Consumer Reports. Go to www.crbestbuydrugs.org to learn more about affordable drug treatment options to discuss with your physician. You'll also learn what you need to know about the effectiveness, safety, and cost of many widely used prescription drugs.