The Brain and Essential Tremor

Medically Reviewed by Christopher Melinosky, MD on April 14, 2022
5 min read

Essential tremor is a nerve disorder that causes shaking that you can’t control in different parts and on different sides of your body. It often affects areas like your hands, arms, head, larynx (voice box), tongue, and chin. The lower body is rarely involved.

ET is not life-threatening unless it keeps someone from caring for themselves. Most people are able to live regular lives with this condition, although they may find it hard to do everyday things like eating, dressing, or writing. It’s only when the tremors become severe that they actually cause disability.

Doctors don’t understand the true cause of essential tremor, but it’s thought that the unusual electrical brain activity that causes it is processed through the thalamus. The thalamus is a structure deep in the brain that coordinates and controls muscle activity.

Genes cause ET in half of all people with the condition. Someone who has ET will have up to a 50% chance of passing down the responsible gene to their child, but the child may never have symptoms. Although ET is more common in older people -- and symptoms become more serious with age -- it is not a part of the natural aging process.

Essential tremor is the most common movement disorder, affecting up to 10 million people in the U.S.

ET can happen at any age, but it most often appears during adolescence or in middle age (between ages 40 and 50).


The main symptoms of essential tremor include:

  • Shaking for brief periods of time that you can’t control
  • Shaking voice
  • Nodding head
  • Tremors that get worse during emotional stress
  • Tremors that get worse when you move on purpose
  • Tremors that lessen with rest
  • Balance problems (in rare cases)

Many other factors or diseases can also cause tremors, including Parkinson's disease, multiple sclerosis, fatigue after exercise, extreme emotional distress, brain tumors, some prescription drugs, metabolic problems, and alcohol or drug withdrawal.

Essential tremor is linked to other illnesses. Other movement disorders, such as Parkinson's disease, have been associated with ET. Some reports have linked ET with migraine headaches. People with ET may also be at high risk of having dementia (particularly Alzheimer’s disease).

Drugs that treat essential tremor may also make you more likely to become depressed.

Some experts think there’s no increased risk for Parkinson's disease for people with ET. Instead, some people diagnosed with ET may be incorrectly diagnosed at first and later turn out to have Parkinson's.

A neurologist or movement disorder specialist can usually diagnose essential tremor based on your symptoms and a complete neurological exam. There is no specific blood, urine, or other test used to diagnose ET.

As part of the exam, your doctor may consider other causes of tremor, such as thyroid disease, too much caffeine, or medication side effects.

Mild essential tremor may not need treatment. But if ET causes problems in your everyday life or if you find it socially unacceptable, treatments may improve symptoms. These can include medications or surgery.

  • Medications. Drugs that you take by mouth can make essential tremor less severe. They include gabapentin (Neurontin), primidone (Mysoline), propranolol (Hemangeol, Inderal, Inderal XL, InnoPran XL), and topiramate (Topamax). Other drug options include the benzodiazepines alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Botox shots may also be a treatment option. This treatment has been effective for vocal and head tremors.
  • Adaptive devices. These are external devices that can help change or control how severe your tremors are. They may help anyone with ET, but people who have disabling tremors are generally not considered good candidates. The devices include neuromodulation devices that you wear and control yourself, and tremor cancellation devices that control hand tremors, allowing you to eat or write.  
  • Deep brain stimulation (DBS). People who have severe tremor despite medical therapy can get help from this surgical treatment. Your doctor implants an electrode in your thalamus and attaches it to a pacemaker-type device under the skin of your chest. The device causes tiny, painless shocks that disrupt faulty electrical messages in the brain.
    DBS offers moderate relief in about 90% of people who get it. It doesn’t destroy brain tissue, and it can be removed or adjusted. But you need brain surgery to put it in place, and some people have symptoms when it delivers a shock.
  • MRI-guided focused high-intensity ultrasound. This uses magnetic resonance imaging (MRI) to focus ultrasound to destroy tissue in the thalamus. The procedure is painless, with no cutting or drilling into the brain. You don’t need anesthesia, and you’re awake and responsive the whole time. But it doesn’t work for everyone, and any improvement in your tremors can fade over time.
  • Thalamotomy. Less often, someone with ET may have surgery to destroy part of the thalamus. It’s usually done on only one side of your brain, to lower the risk of complications. Tremors will get better on the opposite side of your body.
  • Biomechanical loading. External force is applied to a limb or muscle to control the tremor. Studies show that a repeat of this therapy can ease tremors.

Because we don’t know the exact cause of essential tremor, there is no way to prevent it. But knowing that ET has a genetic link gives researchers clues as they look for treatments and prevention.

There is no cure for essential tremor, but treatments that ease symptoms may improve your quality of life. These include drugs and surgery that ease tremor. But not every treatment or procedure is effective for every person with ET. Your doctor will recommend a personal treatment plan, including lifestyle changes that may help reduce your tremors.