Essential Tremor

essential tremor, disorder of the nervous system characterized by involuntary oscillating movements that typically affect the muscles of the arms, hands, face, head, and neck. These involuntary movements often make daily tasks, such as writing, eating, or dressing, difficult. The disorder also may affect the voice and, in rare cases, the legs, sometimes causing difficulty with walking. The tremor is usually absent at rest and is not associated with any other primary symptoms, which distinguishes it from the type of tremor that occurs in Parkinson disease.

Essential tremor is common and affects both men and women. Onset most often occurs in people over age 65, although the disorder can appear in people of all ages. The cause of essential tremor is unknown; however, the disorder does tend to run in families. There are several genetic variations that have been identified in association with essential tremor. The best-characterized variation occurs in a gene known as DRD3 (dopamine receptor 3; formerly designated ETM1, or essential tremor 1). The DRD3 gene encodes a protein called dopamine receptor D3. This receptor binds dopamine, a neurotransmitter that normally inhibits the transmission of nerve impulses in the brain, thereby mediating physical movements. However, the variant DRD3 gene encodes a receptor molecule that alters neuronal response to dopamine, presumably giving rise to the involuntary movements of essential tremor. Variations in a gene called HS1BP3 (HCLS1 binding protein 3) have been identified in association with essential tremor, although the mechanisms by which these variations give rise to the disorder are unclear.

There is no cure for essential tremor; however, there exist a variety of treatments that can be effective in reducing the severity of involuntary movements. In some patients the symptoms of tremors can be controlled through lifestyle and dietary modifications to eliminate stress and the intake of stimulants such as caffeine. Physical therapy can improve muscle control and coordination in the arms and legs of some patients, and speech therapy can alleviate symptoms of mild voice tremor. In cases in which tremor interrupts daily tasks and affects quality of life, drugs or surgery may be necessary to control symptoms. Agents known as beta-blockers (e.g., propanolol), which act on the nervous system to reduce neuronal excitation, are effective treatments, particularly for reducing tremors that affect the hands and voice. In addition, the antiepileptic agent primidone, which reduces neuronal excitation in the brain, is effective in suppressing most symptoms of essential tremor. Patients with essential tremor that does not respond to drug therapy may need surgery, such as deep brain stimulation, to relieve debilitating symptoms; however, because there are dangerous risks associated with brain surgery, it is considered a last resort.