Essential Tremor Symptoms and Treatment

Essential tremor is a neurological condition that causes shaking or trembling in the hands or arms that may progress to involve the head and voice. It rarely affects the legs and feet. The tremor can worsen over time, making daily functions such as writing, eating, drinking, and dressing difficult.

What causes essential tremor?

Experts don’t know what causes essential tremor is unknown; however, research has shown that tremor is associated with changes in the cerebellum, which controls muscle coordination. The condition is also believed to be inherited. Children of a parent with essential tremor have about a 50% chance of developing the movement disorder, too. 

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What are the symptoms of essential tremor?

Early signs of essential tremor may include:

• Fine, rhythmic shaking in the hands, arms, or voice
•  Shaking that worsens when performing tasks like writing or holding a glass
• Shaking that improves when at rest
•  Head nodding or bobbing
•  A quivering voice
• Difficulty with balance and coordination

Over time, the tremor may become more pronounced and result in significant challenges with daily activities. People with arm or hand tremor may find daily tasks and personal care difficult, like holding utensils to eat or write, drinking, applying makeup, or shaving. Even hobbies that require fine motor skills like sewing, painting, playing an instrument, or wood carving can become challenging, causing people to feel discouraged, frustrated, and even embarrassed. 

What are essential tremor treatment options?

Although there is no known cure, there are treatment options that can be for managing and reducing shaking. Options range from medications and physical therapy to adaptive devices, botulinum toxin injections, and surgical procedures and may include:

• Drug therapy with beta-blockers, anti-seizure, and anti-anxiety medications have been shown to have some benefit by targeting different receptors or electrical signals in the body to control tremors.  
• Physical and occupational therapy can improve strength as well as provide adaptive techniques and tools to help with control.
•  Botulinum toxin injections can block the nerve signals that cause muscle contractions, reducing tremors for several months at a time. 
• Non-invasive gamma knife radiosurgery and an incisionless ultrasound procedure are newer options for some patients with essential tremor. With these methods, surgeons can target brain cells responsible for causing tremors without incisions or anesthesia, and therefore, avoiding complications associated with traditional surgery.
• Surgical procedures are typically reserved for patients with severe symptoms or when other treatments have not worked.   Deep brain stimulation is a surgical technique in which electrodes are implanted in the brain to deliver electrical impulses that help regulate abnormal brain signals and help improve the tremors. 

Patient Success Story: Bob’s Life-Changing Tremor Treatment

Bob Bosloper had lived with essential tremor in both hands for over 50 years, since his early twenties. Simple tasks like writing, shaving, and holding coffee became increasingly difficult and embarrassing. Most heartbreaking was his struggle to play the organ at church—a lifelong passion.

“It became very difficult for me to play the organ. I was afraid I was going to land on the wrong chords,” Bob recalls. “I thought my days were numbered playing the organ.”

Medications made him feel groggy without providing adequate relief. When Bob learned about Dr. Hooman Azmi’s focused ultrasound program at New Jersey Brain and Spine, he found new hope.

In 2022, Bob underwent focused ultrasound treatment for his right hand. The procedure uses precisely focused sound waves to target brain circuits responsible for tremor—all while the patient remains awake in an MRI machine for real-time monitoring.

The results were immediate and dramatic. Before treatment, Bob couldn’t draw a simple line around a flag outline. Immediately after the procedure, he could trace the same pattern with steady precision.

“My hand still doesn’t shake. It’s fine,” Bob says about his right hand, which has remained tremor-free for over two years. When FDA approved treatment for non-dominant hands, he eagerly returned for his left hand. “It is so amazing. It is unbelievable, really. You just go into a machine and you are tremor-free,” Bob said after his second treatment. “My quality of life is going to be just terrific now.”

Bob’s transformation was so remarkable it was featured on The Today Show. Now back at church, Bob plays the organ with steadiness he hasn’t experienced in half a century—demonstrating the lasting effectiveness of Dr. Azmi’s innovative treatment at New Jersey Brain and Spine.

What is the incisionless ultrasound procedure? 

A non-invasive, incisionless ultrasound procedure is one of the newest treatment options for essential tremor. Using focused ultrasound, surgeons can target specific areas of the brain without making incisions. Sound waves pass through the skull to heat brain tissue, stopping the abnormal activity that causes tremors. The procedure generally takes about two to three hours, after which patients often notice an immediate and significant reduction in their tremor. Patients will go home the same day. 

In this video, New Jersey Brain and Spine’s Dr. Azmi discusses focused ultrasound for treating essential tremor.

Though essential tremor isn’t life threatening, it can have a significant effect on quality of life. Fortunately, there are now a variety of treatments available to help patients adapt to the condition and regain independence.

Why Choose New Jersey Brain and Spine for Essential Tremor Treatment?

• Leading Movement Disorder Expertise: Dr. Hooman Azmi and our specialized team have extensive experience treating essential tremor and other movement disorders, offering the most advanced treatment options available.
• Comprehensive Treatment Approach: From initial medication management to cutting-edge procedures like focused ultrasound and deep brain stimulation, we provide the full spectrum of essential tremor treatments under one roof.
• Advanced Technology: Our state-of-the-art facilities feature the latest MRI-guided focused ultrasound systems, stereotactic equipment, and neurophysiological monitoring for the safest, most precise treatments.
• Proven Results:Our essential tremor program achieves outcomes that exceed national averages, with over 85% of patients experiencing significant symptom improvement and enhanced quality of life.
• Personalized Care Plans: We understand that each patient’s tremor affects them differently. Our team develops individualized treatment strategies based on symptom severity, lifestyle needs, and personal goals.
• Convenient New Jersey Locations: Access world-class movement disorder care at our modern facilities in Paramus and Annandale, bringing specialized treatment close to home.
• Research and Innovation: As active participants in clinical research, we offer patients access to the latest treatment advances and emerging therapies for essential tremor.

Frequently Asked Questions About Essential Tremor