Essential Tremor

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Essential tremor (ET) is a movement disorder that presents as shaking in the hands. It occurs in about 5% of older adults. It may also cause shaking of the head, voice, arms and trunk. It occurs less often in the legs and feet. Two types of tremor are common with ET:

  • Postural tremor — shaking in certain positions only, such as with arms outstretched
  • Kinetic or action tremor — shaking that gets worse during activities, such as eating or shaving

For some people, ET is caused by a genetic mutation. For others, the cause is not clear. The condition may occur at any age, but it’s more likely to occur in teens and people older than 50.

Symptoms of Essential Tremor 

ET is generally not serious, but its severity may vary and worsen over time. Symptoms may include:

  • Tremor that occurs when standing or moving the limbs, but not usually at rest
  • Uncontrollable, rhythmic movement
  • Shaking is most common in hands, arms, head or voice
  • Shaking only in certain positions or during activity
  • Trouble with fine motor skills such as drawing, sewing or playing an instrument
  • Shaking that gets worse from caffeine, stress, fatigue or heat
  • Shaking that may decrease when using alcohol
  • Problems with social, functional or job-related abilities in more severe cases

Tremors must not be related to other health conditions in order for someone to have the ET diagnosis.

Treating Essential Tremor

Most people with ET do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:

  • Staying well-rested
  • Avoiding caffeine
  • Avoiding stimulants often found in over-the-counter medications, like cold remedies
  • Avoiding temperature extremes

Your doctor may prescribe certain medications to help you function. 

Surgical Alternatives & Innovation

Surgery may be an option in rare cases where tremors are disabling and medications don’t help. Options include:

  • Deep brain stimulation (DBS) — sends painless electrical pulses to the brain, interrupting faulty signals
  • Thalamotomy — destroys a tiny part of the brain (less commonly performed than DBS)
  • Focused ultrasound — ultrasound beams offer precision and fast recovery without surgery

Essential Tremor FAQs

Focused ultrasound is a new, scalpel-free treatment for essential tremor, the most common movement disorder. A UVA team led by Jeff Elias, MD, pioneered this approach in the United States. We're among a select few programs in the country that can offer this treatment. 

What is Focused Ultrasound?

  • Focused ultrasound combines high-frequency (ultrasound) energy with magnetic resonance imaging (MRI). This treatment safely and accurately treats tissue deep within the body without the need for incisions. Elias led a multi-site clinical trial to demonstrate the safety and effectiveness of this approach for treating essential tremor. Researchers are exploring other potential applications. 

How Does Focused Ultrasound Work?

  • Focused ultrasound disrupts the brain activity responsible for the tremors while protecting normal, healthy tissue.
  • What to expect:
    • Your doctor uses MRI to accurately target brain tissue and electrical activity responsible for the tremors
    • Your doctor guides concentrated beams of ultrasound energy to the treatment area
    • The energy beams disrupt the abnormal electrical activity and relieve your symptoms

What Are the Side Effects?

  • Mild numbness or tingling in the fingertips or lips on the side of the body getting treated.
  • Unsteadiness after the procedure
  • Minor side effects, such as headache, pain, warmth and/or dizziness
  • Major side effects, such as stroke, infection or seizures, although the risk for experiencing these is very low

Can I Receive Focused Ultrasound for Other Neurological Disorders?

  • Currently, focused ultrasound is only available for essential tremor. We also care for patients from around the world with rare and complex neurological disorders, including Parkinson’s disease and brain tumors.
  • Find out more about the services we offer.

If I Have Essential Tremor, Does This Mean That I Can Receive Focused Ultrasound?

  • Focused ultrasound is not available for people with certain medical conditions, such as kidney disease, or those who can’t undergo an MRI because they have an implantable medical device, like a pacemaker. Your doctor will discuss the best treatment option for you, including alternatives such as deep brain stimulation.

Do I Qualify for a Focused Ultrasound Thalamotomy?

  • Focused ultrasound thalamotomy is a special focused ultrasound procedure that can be very effective for managing ET. Your care team will evaluate you as a potential candidate for this procedure.
  • Patient selection typically depends on: 
    • Confirmed diagnosis of ET
    • ET has not gotten better with medications such as propranolol or primidone 
    • ET is severe enough to consider a surgical procedure 
    • ET limits your ability to perform daily activities at home or at work 
  • Patients who are deemed potential candidates for focused ultrasound thalamotomy will also need to undergo a special CT scan as part of their evaluation. Because of this, you may be excluded from focused ultrasound thalamotomy if you have a pacemaker or other implanted device.
  • If you are prone to anxiety or claustrophobia, you may have trouble tolerating the 2-3 hour procedure.

What is the Likelihood of Tremor Recurrence?

  • There is always a chance that the focused ultrasound thalamotomy procedure might not work or that the effects will wear off with time. We are unable to guarantee the result or provide refunds for the procedure if it is ineffective. 

Is Focused Ultrasound Covered by My Insurance?

  • The FDA approved the approach in July 2016, but it's not yet covered by insurance.

How Much Does Focused Ultrasound Cost?

When Will You Start Treating Patients Using Focused Ultrasound?

  • We are currently only accepting patients who can pay out of pocket. We’re working on making this available for more patients, it's undetermined when private insurers will begin covering this procedure. In the meantime, our physicians continue to see patients and advise them on the best options for their condition.


Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.