Shaking: Essential tremor or Parkinson’s disease?

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

It’s fair to say, these are shaky times!  In keeping with the rocky ride of 2020, have you noticed your hands shaking lately? Are you having trouble tying your shoes, signing your name, or embarrassed that the glass you’re holding is shaking?

Parents may also have concerns if their child has shaky hand movements. A report from the University of California says that a condition called essential tremor can occur in young children and young adults. This problem increases with age. At around age 60, about 5% of people notice a slight tremor. Another study states that about 1% of the population suffers from tremor.

Essential tremor is the most common form and usually involves the hands and arms, less often other parts of the body. It occurs with movement, not at rest.

This slight shaking can also affect the head, with movement from side to side, or up and down. On rare occasions, it involves the vocal cords, and the voice becomes halting. It may also be associated with poor balance.

No one is certain of the cause. Researchers are studying a part of the brain called the cerebellum which plays a role in movement and muscle control.

Doctors can usually make the diagnosis when symptoms have been present for at least three years, and no other signs of neurological disease are evident. But there are differences between essential tremor and Parkinson’s disease that help doctors to distinguish one from the other.

For instance, considering statistical chances is helpful. Essential tremor is approximately eight times more common than Parkinson’s disease.

Essential tremor normally occurs during action, such as writing, eating or extending an arm to shake hands. But in Parkinson’s disease, the tremor occurs when the arm is not being moved. This is a “resting tremor”.

There’s a difference in the tremor’s frequency and the magnitude. For essential tremor, it’s usually of higher frequency, with more repetitions over a length of time. In Parkinson’s disease, the frequency of movement is slower.

A look to relatives may provide clues. A family history of essential tremor exists in more than 50% of cases; whereas in Parkinson’s disease, only 10-20%.

In terms of symptoms, in essential tremor, the primary issue is anxiety regarding the shakiness. In Parkinson’s, other symptoms appear apart from the tremor, such as rigidity, slowed movements and balance issues.

Treatment of the two is different as well. The majority of people who have essential tremor do not require treatment. In fact, researchers report that those with this condition rarely bother to seek treatment. Or, they wait for many years before seeing a doctor.

A change in lifestyle may ease mild tremors. Since sleep deprivation aggravates tremors, the answer is to get more shut-eye.

There is little doubt that anxiety plays a major role with tremor. Sufferers indicate they try to avoid stressful activities such as public speaking due to the visibility of hand tremors. Yoga, stretching and relaxation exercises can be beneficial. Alcohol also has a moderating effect on tremor as long as used in moderation. Smoking must be eliminated as nicotine aggravates tremor.

For patients with Parkinson’s disease, alcohol has no effect on the disease. But drugs such as levodopa usually provide some improvement of symptoms.

And for parents who notice a child with shaky hands, have a doctor follow the case and keep a journal of what you see. As the child grows and becomes self-conscious of tremors, help them gain confidence through understanding of essential tremor.