Understanding Essential Tremor
clevelandclinic.org/neurorestoration
ConfUsion wiTh Parkinson’s DisEasE
Essential tremor does not affect life expectancy, so it has also been termed benign
essential tremor, but it can become disabling for many common activities, such as
writing, eating or even signing a check.
Because there is less recognition of essential tremor, this involuntary shaking is
often confused with Parkinson’s disease. Symptomatically, the difference between
these movement disorders lies in when the tremor occurs.
• In Parkinson’s disease, tremors are most prominent when the body part is at
rest, and they diminish when it is moving or in action. Also, Parkinson’s patients
typically feel stiffer and slower in their movements.
• In essential tremor, shaking typically occurs with activity and disappears
with rest. Additional symptoms may include a shaky voice, nodding head
and balance problems.
While it can be tricky, it is important to correctly distinguish essential tremor from
Parkinson’s disease because the treatments for these conditions are different.
TrEaTmEnT oPTions
medical
Treatments can reduce essential tremor in many patients. The most widely used
medication is propranolol, a beta-adrenergic blocking drug. A second option is
primidone, an anticonvulsant drug that can also reduce tremors. Another treatment
option, botulinum toxin, is injected directly into the muscles involved in the tremors,
partially weakening the muscles for three to four months, which reduces the tremors.
While many patients are helped with medication, the response is unpredictable:
One person may experience a substantial reduction in tremors with one therapy,
while another may notice only a slight change.
Many people have experienced shaky
hands, especially in times of high stress
or anxiety. But for 5 million Americans,
involuntary shaking — or essential
tremor — is a constant problem.
Essential tremor is an uncontrollable
shaking of the muscles, usually upon
movement. It can occur at any age, but
most commonly begins at middle age.
While the cause of essential tremor
remains unknown, a family history of
tremor exists in about half the cases.
(Continued on back)
ilia itin, mD, meets with a patient diagnosed
with essential tremor.
surgical
Surgical treatment, known as deep brain stimulation (DBS), is considered for people
with tremor who have not been helped by medical therapies. DBS involves the
implantation of a very thin lead containing four electrode contacts into a specific
target area in the brain. The lead extends through a small opening in the skull and is
connected to an extension wire. This wire, in turn, is connected to a pulse generator,
or pacemaker, which is implanted under the skin in the chest.
Patients are awake during electrode implantation to allow the surgical team to assess
brain function. Due to the human brain’s inability to generate pain signals, patients feel
no pain. The pacemaker is implanted either concurrent with electrode implantation
or later, with the patient under general anesthesia for this part of the procedure. The
pacemaker is stimulated for the first time within weeks of implantation.
ClEvElanD CliniC CEnTEr for nEUrologiCal rEsToraTion
Cleveland Clinic Center for Neurological Restoration is among the first in the world
to bring together a team of experts, including renowned neurologists, neurosurgeons,
researchers, psychiatrists, psychologists, physiologists, biomedical engineers, imaging
specialists, physician assistants, nurse practitioners, technicians, and a host of
support personnel and other specialists who offer the latest proven treatments for
people with movement disorders and other neurological conditions. Our team offers
comprehensive, state-of-the-art care at Cleveland Clinic’s main campus.
The center — focused on advancing treatment through ongoing basic and clinical
research — is nationally recognized for expertise in medical management and for
innovations in the surgical treatment of movement disorders (Parkinson’s disease,
essential tremor and dystonia) as well as obsessive-compulsive disorders, depression
and chronic pain.
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Center for Neurological Restoration at 216.444.8001
or toll-free at 800.223.2273, ext. 48001.
For more information, please visit our website at
clevelandclinic.org/neurorestoration.
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neurological institute
The multidisciplinary Neurological
Institute, one of 26 institutes at
Cleveland Clinic, is internationally
known for superior diagnosis and
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ranging from the common to the most
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achievement and innovative research
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therapies unavailable elsewhere, for
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patients with compassion and respect.
Deep brain stimulation electrodes are
implanted in targeted brain areas, with
wires connecting to pulse generators
under the collarbone.