October 9, 2025 Author : Rita Raimundo (neurology) Essential tremor is a very common neurological condition. It is the most common movement disorder , affecting millions of people worldwide. It consists of rhythmic, oscillatory and involuntary movements with an almost constant frequency and variable amplitude. It usually affects the hands, but can also affect the head or other body regions, including the voice. Essential tremor is a benign condition that does not increase mortality. However it can compromise quality of life , potentially leading to a significant dependence for activities of daily living. What is the cause and who can have essential tremor? The exact cause of essential tremor is unknown, which is why it is called idiopathic. It is known that it may have a hereditary component , given that between 30% and 70% of patients have a close relative who is also affected. Some genetic mutations associated with essential tremor are known, although they are not present in most patients. Essential tremor can affect any age group . Its prevalence increases with age, being more frequent after age 60. It is estimated to affect approximately 1% of the general population and 5% of those over 60. Symptoms and diagnosis of essential tremor The characteristic tremor of this condition : Often affects the hands and arms, and sometimes also the head and voice; Is often bilateral; It is typically an action tremor, which means it occurs during voluntary movements or when maintaining arm posture; Mainly interferes with activities such as writing and eating; Rarely occurs at rest (present in only about 20% of cases and when it has a prolonged progression); Stress, anxiety, and caffeine consumption are among the factors that can worsen the tremor. The intensity of the tremor varies from patient to patient. Initially, it may be mild and not interfere with daily life. However, with advancing age and condition, it can become more intense . It can make it difficult or impossible to perform simple tasks such as eating, dressing, maintaining hygiene, writing, using a cell phone, among others. In more extreme cases, people with essential tremor may be dependent on others for these activities. The diagnosis of essential tremor is based on clinical history, symptoms, family history, and exclusion of other possible causes of tremor . There are no tests that can diagnose essential tremor. However, as part of diagnostic investigations, tests may be prescribed to exclude other possible causes of tremor, such as other diseases like Parkinson's disease and dystonia, among others, or iatrogenic/toxic etiologies (medication side effects or exposure to compounds toxic to the central nervous system). Treatment of essential tremor Although there is no cure for essential tremor, there are several treatment options, non-pharmacological, pharmacological, and surgical , that can help control symptoms and improve quality of life. The choice of treatment depends on the severity of the tremor and its impact on daily life, as well as the patient's preferences and expectations. Treatment should only be considered when the tremor interferes with daily activities or is bothersome . Currently, the following treatment options are available: Oral medication (e.g., propranolol, primidone, topiramate, gabapentin, pregabalin, clonazepam); Administration of botulinum toxin (particularly for head tremor); In refractory cases (those that do not respond to the previous strategies): Deep brain stimulation (DBS), with the implantation of a brain device that interferes with the circuits responsible for the tremor; Magnetic resonance-guided ultrasound (MRgFUS) treatment, which causes damage to brain structures associated with the tremor. Furthermore, there are devices specifically developed to help people with essential tremor, ranging from everyday objects to equipment that uses different technologies to help reduce the impact of this condition. Living with essential tremor Essential tremor is a benign but progressive condition that does not affect average life expectancy. However, it can compromise quality of life and significantly impact daily life. Therefore, it is crucial to maintain adequate medical monitoring throughout life to achieve optimal symptom control and adapt as best as possible to the daily difficulties this condition can cause. It is also essential that each person understands their condition well: This way, it will be possible to avoid factors that aggravate tremor, such as stress, anxiety, sleep deprivation, and caffeine consumption; Maintain a healthy lifestyle, including exercise, adapted to the specific needs of each person and their condition, and a balanced diet. Meet the neurology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
