Wednesday, August 31, 2011

Information Regarding Essential Tremor

As I reported in my first blog, I was diagnosed with Essential Tremor (ET) in 1991 long before my PD diagnosis in 2008.  This "evolution" from ET to PD is not typical, but it does happen in some cases.  Essential in this case means unexplained.  Another common name for this affliction is Familial Tremor because it is usually passed on genetically from another family member.  In my case, my mom is 90 years old and has had debilitating ET for the last 10 years.  It normally starts out as a mild condition that is more of a nuisance than anything else.  It does not evolve at the same rate for everyone.  My case was complicated by the fact that I have had tremor attributable to both ET and PD for some time.  In hindsight, I think the PD started to show itself (in addition to the ET) around 2005 especially under stress.  It is difficult to diffentiate the impact of the two conditions (my deep brain stimulaton neurosurgeon could not "quatify" how much of my tremor was caused by PD vs. ET).

ET tremor is typically described as an "action tremor" that occurs most often when using your hands to write, eat, shave, etc.  However, there is also a tremor of the head/neck (axial tremor), legs, and voice that can be a symptom of ET.  Medications used to control ET include propanalol and primidone.   The tremor is usually worse on one side.  Probably the most well-known person with ET was Katherine Hepburn.

PD tremor is typically described as a "resting tremor".  The symptoms are an unexplained twitching or unwanted movement in an arm, leg, hand, finger, etc. that is at rest.  Of course, PD has a host of other symptoms that vary from person to person.  This tremor is caused by the disease and is not the same as the "dyskinesia" symptoms caused by too much levodopa.  Well known persons with this disease include Michael J. Fox, Muhammad Ali, and Janet Reno.

The good news is that both types of tremor that can't be controlled effectively with medication can usually be minimized or eliminated by undergoing deep brain stimulation (DBS) surgery.  It is extremely important to work with a movement disorder specialist (not all neurologists have these credentials).  DBS, including both its' risks and benefits, is something you can discuss with your specialist to see if it is a good alternative for you to explore.

A great resource that I have used over the years to obtain comprehensive information regarding ET is the International Essential Tremor Foundation (IETF).  This is a serious condition that affects 10 million lives in the U.S. alone.  If you would like to donate to support research for this disease, visit


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