Essential Tremor (ET)Why Do My Hands Shake?

Known as familial tremor, benign essential tremor or hereditary tremor, Essential Tremor (ET) is a neurological condition that causes a rhythmic trembling of the hands, head, voice, legs or trunk. Some even feel an internal shake. ET is often confused with Parkinson’s disease although it’s eight times more common, affecting an estimated 10 million Americans and millions more worldwide. Because of stereotypes and a lack of awareness, many people with ET never seek medical care.

You are not alone. Some pretty well-know celebrities and politicians have been affected by ET: actress Katharine Hepburn, the late U.S. Senator Robert Byrd, John Adams (2nd U.S. President), John Q Adams (6th U.S. President), Jonathan Diefenbaker (13th Prime Minister of Canada), playwright Eugene O’Neill, and perhaps even General Douglas MacArthur.

ET an impact individuals both physically and psychologically. It can occur in people of any age, gender, or race and affects every day activities such as eating, drinking and writing. While the severity may vary from person to person, it often makes those affected self-conscious or anxious in social situations. While no cure has been found to date, medications and surgical treatments can help control tremor in many patients.

Essential Tremor – Medication Treatments

Medications Commonly Prescribed for ET:

  • Propranolol (Inderal®) – Propranolol is the only medication approved by the Food and Drug Administration (FDA) for the treatment of ET and is available in immediate and long-acting formulations. Propranolol is a beta-blocker that is a drug used primarily for treating high blood pressure. Side effects of propranolol are usually mild and are more frequent at higher doses. The main side effects are decreased heart rate and blood pressure. Tell your doctor if you have heart failure, diabetes, or asthma. Patients who respond usually require a total daily dosage of 240 mg or less. Other beta-blockers such as atenolol, metoprolol, and nadolol can also be beneficial for treating ET.
  • Primidone (Mysoline®) – Primidone is an anti-seizure medicine that can be effective in treating ET. Although it might have initial side effects such as nausea, poor balance, dizziness, fatigue, drowsiness, and flu-like symptoms, these side effects often resolve over time. To reduce the possibility of side effects, start with a small dose at bedtime (12.5 mg or one-quarter of one tablet) and gradually increase the dosage according to your doctor’s instructions.
  • Clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®), and alprazolam (Xanax®) – These anti-anxiety medications may be useful in patients who do not respond to other medications or who have associated anxiety. Side effects include sleepiness, dizziness, depression, fatigue, loss of coordination, memory loss, and confusion. These drugs are usually less effective than propranolol and primidone, and they can be addictive. There is also risk of withdrawal symptoms if the drugs are stopped suddenly.
  • Topiramate (Topamax®) – Topiramate is an anticonvulsant that has been shown to be effective in controlling tremor in some patients. Side effects include numbness or tingling, memory loss, and weight loss.
  • Gabapentin (Neurontin®) – Gabapentin is a generally well tolerated anticonvulsant, but controlled studies have produced conflicting results regarding its efficacy in ET. At best, this drug has a very modest benefit. It is tried by patients whose tremor is unmanageable by other medications. Side effects include fatigue, slurred speech, drowsiness, impaired balance, and nausea especially when beginning drug therapy.

Essential Tremor – Surgical Treatments

Essential tremor (ET) is one of the most common movement disorders, yet only about 50 percent of patients receive satisfactory benefit from the currently available medications. For patients with disabling tremor that is not adequately controlled by propranolol, primidone, or other medications, surgical treatments may be an option. Advances in the understanding of brain anatomy, more detailed imaging methods to better see the brain, and improved surgical techniques now allow for greater surgical accuracy and increased benefits with fewer complications than when surgical treatments were first introduced.

Current surgical options for ET include deep brain stimulation (DBS) and thalamotomy. Potential candidates for surgical procedures are ET patients who do not experience satisfactory tremor control with medications, and who have disabling tremor that affects their ability to perform activities of daily living such as eating, writing, drinking, dressing, working, or enjoying their hobbies.

International Essential Tremor Foundation (IETF)

International Essential Tremor Foundation (IETF)There is a wealth of information at
Download “Why Do My Hands Shake” here
Download “The Difference Between ET and Parkinson’s Disease” here

Assisted Technology for ET

Lift Ware: Sensors in the handle of this high-tech spoon detect your hand tremor and quickly respond to cancel the tremor and steady the spoon. It allows you to focus less on how you are eating and more on the people you’re eating with. $295.00. Visit Lift Labs website to learn more. The IETF is not a retailer for Lift

SteadyMouse Hand Tremor Mouse Accessibility Software (Free Download): Free software designed to assist people with hand tremor. Major Features: Anti-tremor mouse filtering. Removal of accidental mouse clicks. Assistive “Icon Targeting” system. Quick enable/disable using the scroll lock key. Simple design for easy configuration. Visit the SteadyMouse website for more information.

Chester Creek Keyboards: The KeyGuard––designed to help people who may have trouble pressing only one key at a time––is designed for use with the company’s large-key keyboard models: VisionBoard2, KinderBoard, MyBoard-lc and MyBoard-UC. The The large-format buttons make it easier to press the right key when typing. The KeyGuard is an easy-to-clean, metal frame that fits securely over the keyboard and provides physical separation between each key.

Metal Pen from Poppin: IETF member Tracy Joslin often found her shaky hands to be an obstacle – until she discovered the Poppin Pen. These heavy-weighted, ball-point pens provide the stability needed to accomplish everyday writing tasks. “My penmanship used to be perfect, and it is nice to gain some control back,” says Tracy. At a retail price of $14, Tracy recommends the metal pen for those who struggle with hand tremor. Pens can be purchased at in a wide array of fun colors.

Steady Write Pen by ActiveForever: The Steady Write pen is a unique writing instrument for either the right or left hand. We have found the Steady Write pen is a helpful tool for those who have weakened grasp due to arthritis or limited use of hands when writing due to neurological disorders. The Steady Write pen helps improve handwriting by using the friction of the base to smooth out the motion of your writing. The solid base balances and guides the hand as you write. The hand does not touch the pen but simply guides the base across the paper.>

Pen and Pencil Weight Kit:
The weighted button aid has a plastic vinyl handle is designed with finger grips to improve grasp. The added internal weight assists in stabilizing the hand of those persons with unsteady hands or tremors. Measures 1 1/8 x 7 1/2 inches long.

Information provided on this website and in the Doctor’s Blog is for informational and educational purposes only. It is not intended as and does not substitute for medical advice. Please consult your health care professional for evaluation of your individual case.