Warning Signs Of Essential Tremor

Essential tremor is a neurological disorder where an individual experiences rhythmic and involuntary shaking in any part of their body. An inherited genetic mutation on chromosome 3, chromosome 2, or chromosome 6, is the cause for over half of all diagnosed cases of essential tremor. In the other half of cases, the cause of essential tremor is unknown. There is no particular test to make an essential tremor diagnosis. A physical examination and a thorough neurological examination are used to diagnose essential tremor. 

MRI scans are used in the process of elimination of disorders that can produce similar symptoms. Some individuals diagnosed with essential tremors do not require treatment. However, medications to help control the shakiness in the body may be necessary to keep symptoms from interfering with daily activities and tasks.

Periodic Uncontrollable Shaking

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An individual affected by periodic uncontrollable shaking may be affected by essential tremor. This uncontrollable shaking most often occurs in the parts of the body controlled by voluntary muscles. Periodic uncontrollable shaking is most common in an individual's face, head, hands, neck, thumb, and arms. At first, the periodic uncontrollable shaking in the affected body part may be mild and barely noticeable during regular activities. Sometimes these uncontrollable rhythmic movements will cease entirely when the affected muscles are at rest or when the individual is sleeping.

At other times, the involuntary movements will worsen when the individual is attempting to make a targeted movement with the affected muscles. The periodic shaking can worsen over time as the affected individual advances in age. This involuntary shaking can spread from the body part that has been initially affected on to other body parts depending on the underlying cause of essential tremor.

Nodding Head

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An individual with essential tremor may experience uncontrollably nodding their head. While the most prevalent part of the body to be affected by essential tremor is the hands, some may experience essential tremor in their head. A head tremor precipitated from essential tremor is a regular tremor that exhibits a rhythmic and repeated shaking action an affected individual is unable to control. Around thirty-five percent of all essential tremor patients experience the nodding head or head tremor independently or with hand tremors. 

An individual who experiences a nodding head caused by essential tremor will not experience a change in their condition upon changing the direction of their head. A nodding head or head tremor associated with essential tremor will disappear when the patient is lying down and sleeping. Individuals who have a family history of tremor are more likely to develop head nodding or a tremor of the head.

Shaking Voice

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An individual whose voice shakes frequently may be affected by essential tremor. Shaking voice and vocal tremor are terms used to describe when an individual experiences involuntary movements of the muscles located in their throat, vocal cords, and voice box. In rare cases, a tremor in the muscles located in an individual's chest, mouth, or abdomen may be the cause of their vocal tremor. A vocal tremor is almost always due to rhythmic muscle movements when it is caused by essential tremor. 

The rhythmic muscle movements in the muscles that control the voice can result in a quivering sound in the affected individual's voice. An individual who has a shaking voice may experience alterations in the pitch or volume of their voice and interruptions in their production of vocal sounds. Because the muscles in an individual's throat, voice box, and vocal cords weaken as they advance in age, a shaking voice from essential tremor most often manifests in the fifth or sixth decade of life.

Tremors Worsening With Stress

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An essential tremor patient may notice their symptoms become worse with stress. Stress manifests with changes in an individual's physical state, mental state, and emotional state. Common causes of stress include confrontations, deadlines, job loss, new job, death of a loved one, divorce, marital difficulties, legal problems, retirement, illnesses, and financial problems. The worsening of essential tremor when the individual is under stress falls under the physical changes that occur in their body. 

Other physical changes, besides shaking, induced by stress include sweaty palms, weight gain, weight loss, erectile dysfunction, chronic fatigue, and stooped posture. The mechanism behind how stress causes a patient's essential tremor to become worse is not clear, but it is thought to be associated with how the stress response speeds up numerous chemical and molecular processes in the body. The increased speed of these processes can exacerbate the effect of the inappropriate nerve signals that cause essential tremor.

Issues With Balance

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An individual with balance issues may also be affected by essential tremor. Essential tremor patients can exhibit several different characteristics in the way they walk that can explain why they would experience issues with their balance. Individuals who have essential tremor may have a more variable stride and a wider step than those who do not. These changes in gait are not readily noticeable upon first or second glance but have been identified in multiple studies as the main component of the pathophysiology of balance problems in essential tremor. 

Individuals who experience the subtype of essential tremor known as kinetic tremor, a tremor of the head, and a vocal tremor are at a greater risk of developing issues with balance. It should be acknowledged that some medications used to treat symptoms of essential tremor have also been known to produce issues with balance and dizziness as a side effect.

Tremors Worsening Due To Fatigue

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An individual affected by essential tremor may experience worsening tremors due to fatigue. The medical term used to describe a tremor that becomes more pronounced with fatigue is an enhanced physiologic tremor. The only way this symptom is identified is a noticeable increase in tremor movement when the affected individual does not have an adequate amount of energy in the body. It is thought that an affected individual's voluntary muscle groups are affected in the pathogenesis of this manifestation of essential tremor. 

Certain nutrients and an adequate amount of water in the body are required for the nerves and muscles to work together properly. A fatigued individual may have depleted levels of fluids, vitamins, or minerals in their body that are important to the functionality of their nerves, nerve impulses, and muscle fibers. Inadequate amounts of water in the body cause the involuntary contraction of muscle fibers, and deficiencies in certain nutrients can disrupt electrical impulses between nerves. A combination of these mechanisms produces worsening tremors due to fatigue.

Worsen With Movement

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An essential tremor patient may experience symptoms that worsen when they make certain movements. An individual with essential tremor tends to experience more pronounced tremors when they are attempting to use fine motor skills to accomplish normal daily activities, including eating, writing, applying makeup, shaving, brushing teeth, drinking, and typing. This manifestation of essential tremor can greatly impair an individual's ability to accomplish such essential tasks. 

It is thought that essential tremor is the result of incorrect communications between an affected individual's cerebellum and other parts of their brain. The cerebellum is the part of the brain responsible for the proper coordination of muscle contraction and relaxation. Because essential tremor is thought to be caused by the abnormalities related to muscle movement and coordination, an affected individual is likely to experience worsening symptoms when they are making purposeful and voluntary movements of their muscles.

Comparison To Parkinson's Disease

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Several key differences can be used to distinguish essential tremor from Parkinson's disease. The tremor seen in Parkinson's disease patients mostly occurs when they are at rest, where the tremor seen in essential tremor occurs mostly during movement. Individuals affected by essential tremor are more likely to have a family history of the condition, whereas Parkinson's disease patients rarely have a family history of tremor. An individual who has Parkinson's disease is more likely to have a tremor that begins unilaterally (on one side of the body), and an essential tremor patient experiences symptoms bilaterally or on both sides of their body. 

A Parkinson's disease patient tends to experience no effects when they consume alcohol, whereas an individual with essential tremor experiences an improvement in symptoms with the consumption of alcohol. Someone affected by Parkinson's disease will experience other symptoms like slowed movements, problems with balance, unsteady gait, and rigidity, and an individual with essential tremor does not experience these manifestations.

Aggravated By Extreme Temperatures

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An individual with essential tremor may experience an aggravation of their symptoms when their body is exposed to extreme temperatures. Nerve impulse conduction and the functionality of the muscle fibers are altered in healthy individuals when they are exposed to extremely hot or extremely cold temperatures. Therefore, an individual who has essential tremor is likely to experience more difficulty with their symptoms when they are in extremely hot or cold temperatures. 

Cold temperatures naturally cause a decrease in overall blood flow to the muscle tissues and induce shivering movements for heat generation in the body. These compensatory mechanisms cause increased difficulty for an affected individual because they are compounded by the abnormalities that occur because of essential tremor. Hot temperatures have not been concluded to make essential tremor worse or better in any large population of patients because not enough information is available regarding the impact of hot temperatures.

How Tremors Begin

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The symptoms of essential tremor may begin at any age, but it is most common in those over forty years old. Most individuals who have essential tremor will experience a rhythmic motion of both of their hands that becomes more prominent in certain physiologic situations. Some essential tremor patients do not experience the progression or worsening of symptoms over time, when others may experience a rapid progression of symptoms as they age. It is thought many individuals affected by essential tremor experience the slow movement of symptoms from their hands to their arms, and from their arms to their trunk. 

Essential tremor may move from an individual's arms to their chest, neck, or head. Some patients may experience symptoms of essential tremor more prominently on one side of their body than the other side initially. It is much less common for an individual to experience the movement of their symptoms down their trunk and into their legs, but it does happen in a small number of cases.

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