Essential tremor is a type of involuntary shaking movement. It is a progressive neurological disorder and the most common of the movement disorders.

The exact cause of essential tremor is unknown. Research suggests that the part of the brain that controls muscle movements does not work correctly in people with essential tremor.

About 1 million people in the United States suffer from essential tremor. About 30 percent of people with essential tremor have a family member with the symptoms. It can affect people of all ages though the average age of onset is 45.

Essential Tremor Symptoms

Tremor is the only symptom of essential tremor and typically occurs in the limbs, head, trunk or voice. Both sides of the body are affected. Stress or anxiety can make the tremor worse.

A person with essential tremor may have trouble holding or using small objects such as silverware or a pen.

Usually, there is a difference between the tremor of a patient with Parkinson’s disease and that of a patient with essential tremor. In Parkinson’s, the tremor may be reduced in the afflicted body part when it is in use. With essential tremor, the tremor may increase.

Essential Tremor Treatment

The main goal of essential tremor treatment is to keep movements as normal as possible with the smallest amount of medication, since many medications can cause side effects.

Therapies may be necessary to help patients with language and movement.

Essential tremor cases that do not respond to medication may require surgery, often aimed at interrupting abnormal movements.

Essential Tremor Treatment: Surgical Options

One essential tremor procedure is pallidotomy, a computer-assisted neurosurgery, aimed at reducing tremor, rigidity and other symptoms by destroying the areas of the brain that caused these symptoms. Another option is thalamotomy, which involves making a lesion in the thalamus, the area of the brain that is the source of tremor. Both procedures are irreversible and may have permanent side effects.

Deep brain stimulation (DBS) is a procedure where electrodes are placed in specific areas of the brain. The electrodes block the abnormal brain circuitry seen in patients with neurological conditions such as Parkinson’s disease, essential tremors and dystonia.

DBS does not destroy the overactive cells, like other movement disorders treatments such as pallidotomy and thalamotomy surgeries. Rather, it temporarily blocks the abnormal signals and is a reversible process. In DBS, a lead is permanently implanted into your brain and connected to a generator, which is attached under the skin of your chest.

An alternative to making a lesion with an electrode is to use highly focused radiation. Two types of devices can be used to deliver stereotactic radiosurgery, namely the Gamma Knife® and the LINAC-Scalpel.

Focused ultrasound  is an incision-free brain surgery that can provide same-day hand tremor relief for essential tremor and Parkinson’s disease. Atrium Health Wake Forest Baptist is the only health system in the Triad that offers focused ultrasound.

Guided by magnetic resonance imaging (MRI), focused ultrasound waves are used to precisely target the area of your brain that controls your tremor. By carefully heating and removing these cells, we can safely reduce or stop hand tremor symptoms with a single procedure.

This procedure may also be referred to as high-intensity focused ultrasound (HIFU), MRI-guided focused ultrasound or incisionless brain surgery. Unlike deep brain stimulation, focused ultrasound doesn’t require any surgical incisions. 

Wake Forest Baptist Multidisciplinary Approach

The treatment of movement disorders at Wake Forest Baptist is a collaborative effort between neurologists and neurosurgeons.

Quality of life is further enhanced by the participation of physical, occupational and speech therapists, and otolaryngologists who have special expertise in speech and swallowing difficulties.