HCA Midwest Health - March 22, 2018

Any time your body starts acting in a different way or showing new "symptoms," it can be frightening, particularly with something like tremors — shaking hands that you can't seem to control. It's easy to immediately assume the worst case health scenario, but there's no need to do so, says Dr. Phaedra Dowell, a board-certified, fellowship-trained movement disorders specialist with Menorah Medical Center's Movement Disorders Clinic. There are a number of reasons for hand tremors.

What causes "shaky hands?"

The clinical term for shaking hands is "tremors," involuntary or uncontrolled movements. Most people associate tremors with Parkinson's disease, and although that is correct in some cases, there are many other causes including:

  • Medications
  • Drug or alcohol withdrawal
  • Lifestyle (stress, a lack of certain vitamins, low blood sugar, hunger, or other physiological conditions)
  • Hyperthyroidism (an overactive thyroid gland)

In cases where tremors have a specific cause (like the above), the tremors will generally subside once the cause is alleviated or treated.

The most common cause of tremors that don't go away is a condition called essential tremor. In fact, the condition is the most common movement disorder in the United States, impacting up to 10 million people. Essential tremor may start with hands and then possibly move to other parts of the body such as the head or neck. It can also sometimes start in the head or, as in some patients, never affect the head. With essential tremor, the hands tend to shake when you are doing something — taking a drink of water, writing, tying your shoe, etc. This is different from tremors resulting from Parkinson's disease, which are typically "resting tremors," meaning the hands shake when they are not doing anything, such as resting in the lap. Essential tremor is not life-threatening, nor does it cause serious health issues. That said, severe shaking hands can make it difficult to eat, drink, write or perform other fine motor activities.

What causes essential tremor?

We don't understand the exact causes of essential tremor. For some, the tremor tends to run in the family, but others may have no family history at all. Age also plays a factor, with an increased likelihood of developing essential tremor after age 40. And although essential tremor is not caused by lifestyle factors, things like emotional stress, hunger, fatigue or even very cold or hot temperatures can make it worse.

How is essential tremor diagnosed?

If tremors continue for a period of time, you should visit a doctor. There is no test to definitively diagnose movement disorders, so a thorough physical performed by a specially trained neurologist is the best diagnostic tool. A movement disorders specialist is able to observe your tremors with an experienced eye, check your muscle strength, reflexes, coordination and other functions, and ask you questions. The physician may also order blood tests. This total view of your health helps him or her determine if the condition is essential tremor, or something else.

Will tremors get worse?

In general, with essential tremor, shaking does become more pronounced and frequent with age. And again, although they cause no serious health issues, hands that become more and more shaky can make everyday tasks difficult, and for some, prove to be socially embarrassing. This can lead to isolation, depression, or other emotional concerns. It is important to see a physician for diagnosis and appropriate treatment.

The speed of progression of the condition remains constant throughout a person's life, says Dr. Dowell. In most cases, tremors come on gradually and will continue to progress at the same rate (meaning it’s unlikely you will wake up one day and suddenly have severe tremors).

How is essential tremor treated?

One of the first things the specialist will want to determine is how disruptive the tremors are to your life. For many, the tremors are mild enough that they are not treated. But as they worsen, a physician may prescribe medications or treatment:

  • Propranolol – a medication normally used to treat high blood pressure, can sometimes be effective
  • Gabapentin, topiramate – anti-seizure medications have been used effectively in some patients
  • Physical or occupational therapy – As with many conditions, exercise can prove to be beneficial. Based on symptoms, a physical or occupational therapist can teach you special exercises and show you tools that may help with everyday activities. For example, there are special spoons that counteract the tremor, special pens, instruments that help someone button their shirt and even button-down shirts that are magnetic so someone doesn’t have to fumble with the buttons
  • Deep Brain Stimulation – In severe cases, or when medication no longer controls symptoms, a neurologist may recommend a surgical procedure called Deep Brain Stimulation (DBS). During this procedure electrodes are implanted in specific parts of the brain and connected via thin wire to a "pacemaker" type device implanted underneath the skin of the chest. The electrodes create electrical signals that regulate the brain's abnormal impulses and help control the tremors

Can essential tremor be cured?

There is currently no cure for essential tremor, however, treatments can relieve the symptoms and enhance your quality of life.

Movement Disorders Experts in Kansas City

The HCA Midwest Health Neuroscience Institute is one of the Kansas City area’s leading treatment centers for conditions involving the brain, spine and nerves. We offer comprehensive care for patients with essential tremor and other types of movement disorders at Lee’s Summit Medical Center, Menorah Medical Center, Overland Park Regional Medical Center and Research Medical Center. Our neurologists have years of experience treating essential tremor and can work with you to develop a customized treatment plan that fits your lifestyle.

Find a Movement Disorder Specialist

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