# Essential tremor | Symptoms, Causes, Tests and Treatment | OSANG > Essential tremor is a common movement disorder with a prevalence of approximately 0.4-3.9% in adults and approximately 5% in people over 65 years of age. Hyperactivity o… - Official page: https://osns.co.kr/en/encyclopedia/essential-tremor - Organization: OSANG Neurosurgery ## Page content Neurological Conditions ## Essential tremor Essential Tremor · G25.0 Essential tremor is the most common movement disorder characterized by rhythmic tremors that occur mainly in both hands when maintaining posture or making intentional movements. ## At a glance Essential tremor is a common movement disorder with a prevalence of approximately 0.4-3.9% in adults and approximately 5% in people over 65 years of age. Hyperactivity of the cerebellar-thalamic-cortical circuit is the core of the pathophysiology, and the improvement at rest and worsening during movement is what differentiates it from Parkinson's disease. Propranolol reduces tremor in approximately 50-60% of patients as a first-line drug treatment, and deep thalamic brain stimulation is effective in drug-refractory patients. - 01Definition and Overview - 02Causes and Pathophysiology - 03symptoms - 04diagnosis - 05treatment - 06prognosis ## Definition and Overview Essential tremor (ET) is the most common movement disorder in adults. Rhythmic and repetitive tremor occurs mainly in both hands when maintaining posture (postural tremor) or intentional movement (kinetic tremor), and is characterized by improvement at rest. The prevalence is approximately 0.4 to 3.9% in all adults, and increases to approximately 5% in those aged 65 or older. There is often a family history, and in the past it was classified as a benign disease, but recently the progressive neurodegeneration aspect has been attracting attention. ## Causes and Pathophysiology Hyperactivity and dysfunction of the cerebello-thalamo-cortical circuit are known to be key to the pathophysiology of essential tremor. In particular, it is believed that abnormal vibration of the olivocerebellar pathway between the inferior olive nucleus and the cerebellum causes tremor. Genetic factors are also important. A family history is confirmed in approximately 50-70% of patients, and autosomal dominant inheritance patterns are often observed. LINGO1 and SLC1A2 have been reported as related genes, but a single causal gene has not yet been established. ## symptoms Tremors mainly appear symmetrically in both hands and forearms, and are noticeable during daily activities such as writing, eating, and drinking water. The main symptoms and aspects are as follows. - Hand tremor: worsens with movement, improves with rest (key differentiator from Parkinson's disease) - Head tremor: occurs in yes-yes (vertical) or no-no (horizontal) direction. - Voice tremor: A pattern in which the voice shakes when speaking. - Leg tremors are rare and usually occur in severe cases. A temporary decrease in tremor after alcohol consumption is observed in approximately 50-70% of patients. ## diagnosis Essential tremor is a clinical diagnosis. Diagnosis is made through a characteristic history and physical examination (confirmation of movement tremor), and it is important to rule out hyperthyroidism, drug-induced tremor, Parkinson's disease, and cerebellar disease. A dopamine transporter scan (DaT scan) can be performed to differentiate it from Parkinson's disease. In essential tremor, DaT scan shows normal results, whereas in Parkinson's disease, dopamine transporter binding in the striatum is reduced. Nerve conduction testing and brain MRI are performed when there is atypical clinical pattern or when secondary causes need to be determined. ## treatment ### medication Propranolol is a non-selective beta-adrenergic blocker and is the first-line treatment. In clinical studies, it has been reported to significantly reduce tremor amplitude in approximately 50-60% of patients. Caution is required when using it in patients with asthma, bradycardia, or low blood pressure. Primidone is an anticonvulsant that has similar effects to propranolol and is recommended as a first-line treatment. Because there are initial side effects such as drowsiness and dizziness, start at a low dose and gradually increase the dose. Other drugs such as gabapentin, topiramate, and alprazolam can be considered as second-line treatment. ### surgical treatment In severely ill patients who do not respond sufficiently to drug treatment, surgical treatment is considered. - Deep brain stimulation (DBS): This is a method of applying high-frequency stimulation by inserting an electrode into the ventromedial nucleus (VIM) of the thalamus, which significantly reduces tremor in about 60-80% of cases. - Focused ultrasound thalamotomy (MRgFUS thalamotomy): A non-invasive method that destroys the thalamic VIM by focusing ultrasound without opening the skull. ## prognosis Essential tremor is not life-threatening, but tends to progress slowly. It can affect daily life functions and reduce quality of life. Symptoms can be controlled in most patients with drug treatment, and surgical treatment is chosen in cases where there is severe functional decline. --- This information is provided for medical educational purposes and is not a substitute for individual medical care or treatment. If you have any symptoms, be sure to seek professional advice. Inquiries: Osang Neurosurgery 1599-5453 | osns.co.kr ## Related articles - delirium - Cervical radiculopathy - Cervical disc herniation - dystonia This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.