Essential Tremor

John Crowe's hands were often shaky, but MRI-guided focused ultrasound treatment made his tremor decrease. Read John's story.

The most common movement disorder, essential tremor affects about 10 million Americans. The uncontrollable, rhythmic shaking it causes can be so debilitating that simple things like eating a meal, writing or holding a tablet are difficult to do.

University of Maryland Medical Center (UMMC) is at the forefront of advanced treatments for essential tremor and other movement disorders. We offer patients the very latest in essential tremor treatment, MRI-guided focused ultrasound (FUS), in addition to traditional options like medication and deep brain stimulation. UMMC conducted the groundbreaking clinical trial research that led to FUS becoming an FDA-approved treatment for essential tremor, and we are one of the few hospitals in the United States currently offering this noninvasive procedure.

Symptoms of Essential Tremor

In addition to involuntary movement in the hands and arms, essential tremor can also affect:

Your head (causing uncontrollable "yes-yes" or "no-no" head-shaking movements)
Your voice (causing it to tremble and fluctuate in volume)

In about half of cases, tremor symptoms are attributed to a genetic mutation that can be passed down within families. Though researchers are unsure of the causes in other cases, the risk of developing essential tremor does increase as you get older. It is not considered a dangerous neurological (nervous system) disorder, but essential tremor can worsen over time and greatly affect your quality of life.

Tremors tend to be worse during movement than when at rest.

Making a Diagnosis

Part of what makes essential tremor difficult to diagnose is it is often mistaken for Parkinson’s disease. Although the conditions are similar, there are some key differences:

Symptoms of essential tremor occur during action while maintaining a position and not at rest. However, tremor activity related to Parkinson’s disease does occur at rest.
Essential tremor movement is a faster, more confined motion; movements associated with Parkinson’s disease are slower and longer.

There is no definitive test for essential tremor, so doctors make a diagnosis based on:

Your medical history (including your family history)
A neurological examination that includes assessments of coordination, balance, strength, reflexes and movement
A physical examination
Lab tests to rule out other conditions that may be causing your symptoms

Experienced doctors can identify the small but distinct differences between essential tremor and Parkinson’s disease.

Treatment

MRI-guided focused ultrasound (FUS) is the newest technology offered at UMMC for treating essential tremor and other tremor-dominant movement disorders. We also offer traditional treatment options:

Medications

As a first step, your doctor may prescribe a medication, such as propranolol, to control your essential tremor symptoms. Over time, however, your body may develop a tolerance to the drug, meaning the longer you take it, the less effective it may be.

Deep Brain Stimulation

The standard of essential tremor care for more than 15 years, deep brain stimulation (DBS), unlike FUS, is an invasive procedure. It involves drilling a hole in the skull and implanting electrodes in the brain to improve essential tremor symptoms. Wires run under the skin from the brain to a pacemaker that is inserted in your chest.

DBS can lead to remarkable improvements, but it does require multiple surgeries. Depending on the battery type in the DBS device, a surgical procedure may be required every two to five years.

Learn more about deep brain stimulation.

Contact Us

For more information about essential tremor and its treatments or to make an appointment, email us at FocusedUltrasound@som.umaryland.edu or call 410-328-3514.