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Genetic and Rare Diseases Information Center (GARD)

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Essential tremor

Other Names for this Disease
  • Benign essential tremor
  • Familial essential tremor
  • Hereditary essential tremor
  • Presenile tremor syndrome
  • Tremor, hereditary essential, 1
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Your Question

I have a relative who has essential tremor. How might this condition affect the activities of daily living? Are there ways to manage the symptoms?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is essential tremor?

Essential tremor is a disorder of the nervous system that causes involuntary, rhythmic shaking (tremor), especially in the hands. It involves tremor without any other signs or symptoms, and is distinguished from tremor that results from other disorders or known causes, such as tremors seen with Parkinson disease or head trauma.[1] Essential tremor (sometimes called benign essential tremor) is the most common of the more than 20 types of tremor.[2] Essential tremor is a complex disorder. Several genes are believed to help determine an individual's risk of developing this condition. Environmental factors may also be involved.[1] In mild cases, treatment may not be necessary. In cases where symptoms interfere with daily living, medications may help to relieve symptoms.[3] 


Last updated: 5/6/2013

What causes essential tremor?

Essential tremor is a complex disorder.[1] About half of all cases of essential tremor appear to occur because of a genetic mutation. This is referred to as familial tremor.[4] Several genes are believed to help determine an individual's risk of developing this condition.[1] 

Some studies have found the DRD3 gene to be associated with essential tremor. The DRD3 gene provides instructions for making a protein called dopamine receptor D3, which is found in the brain. This protein responds to a chemical messenger (neurotransmitter) called dopamine to trigger signals within the nervous system, including signals involved in producing physical movement. A DRD3 variant seen in some families affected by essential tremor may cause the corresponding dopamine receptor D3 protein to respond more strongly to the neurotransmitter, possibly causing the involuntary shaking seen in this condition.[1]

In other studies, the gene HS1BP3 has also been associated with essential tremor. The HS1BP3 gene provides instructions for making a protein called hematopoietic-specific protein 1 binding protein 3. This protein is believed to help regulate chemical signaling in the brain region involved in coordinating movements (the cerebellum) and in specialized nerve cells in the brain and spinal cord that control the muscles (motor neurons). An HS1BP3 variant has been identified in some families affected by essential tremor, but it has also been found in unaffected people. It is unknown what relationship, if any, this genetic change may have to the signs and symptoms of this condition.[1]

Exactly what causes essential tremor in people without a known genetic mutation isn't clear.[4] Environmental factors may be involved.[1]
Last updated: 10/11/2011

Can the symptoms of essential tremor interfere with the activities of daily life?

Although essential tremor is not life-threatening, it can make it harder to perform daily tasks and is embarrassing to some people.[1][2][4] Hand tremor is most common but the head, arms, voice, tongue, legs, and trunk may also be involved. Although it may be mild and nonprogressive in some people, in others the tremor is slowly progressive, starting on one side of the body but eventually affecting both sides.  Tremor frequency may decrease as a person ages, but the severity may increase, affecting the person's ability to perform certain tasks or activities of daily living. In many people the tremor may be mild throughout life.[2]

If severe, essential tremor may interfere with fine motor skills used to do simple tasks like holding eating utensils, drinking a glass of water, tying shoelaces, writing, sewing, shaving, or applying makeup.[1][2][3][4] Sometimes the tremors affect the voicebox, which occasionally leads to speech problems.[3][4]

The symptoms of essential tremor may be aggravated by emotional stress, fever, fatigue, hunger (low blood sugar), caffeine, cigarette smoking, or extremes of temperature.[1][2] 

Last updated: 5/6/2013

How might essential tremor be treated?

Treatment for essential tremor may not be necessary unless the tremors interfere with daily activities or cause embarrassment.[3] Although there is no definitive cure for essential tremor, medicines may help relieve symptoms.[2][3] How well medicines work depend on the individual patient.[3] Two medications used to treat tremors include:[2][3]
  • Propranolol, a drug that blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline
  • Primidone, an antiseizure drug that also control the function of some neurotransmitters

These drugs can have significant side effects.[3]

Eliminating tremor "triggers" such as caffeine and other stimulants from the diet is often recommended. Physical therapy may help to reduce tremor and improve coordination and muscle control for some patients.[2]
More details about the management of essential tremor can be accessed through the following web links:

Last updated: 5/6/2013