Why Do My Hands Shake?

Involuntary shaking of the hands or arms is often associated with Parkinson’s disease, but essential tremor (ET) is one of the most common movement disorders with similar symptoms. A neurological evaluation and an accurate diagnosis can lead to life-changing treatment for people with this nervous system disorder.

“In the United States, up to 10 million people are affected by ET,” says Corneliu Luca, M.D., Ph.D., a movement disorders neurologist with the University of Miami Health System. While ET is considered benign, the condition progresses slowly and can lead to significant disability. In advanced stages of the disease, people with ET can have difficulty with balance, hearing loss, and memory. Fortunately, ET is not life-threatening.

About half of those diagnosed with ET inherited the neurological condition through a DNA alteration. Others develop ET with no known cause. This disorder is more common in adults over age 40.

What’s the difference between ET and Parkinson’s disease?

While tremors are the most recognizable symptom of Parkinson’s disease (PD), it often also involves slow movement, muscle stiffness, and changes in walking and balance. People with PD may also develop sleep disorders, loss of sense of smell, and constipation.

ET, on the other hand, is an isolated tremor disorder for which tremors in both arms is often the only symptom. “ET tremor happens while you do things — when you’re eating or bringing a cup to your mouth,” says Ihtsham UI Haq, M.D., a UHealth neurologist specializing in movement disorders and chief of the Movement Disorders Division. “PD tremor happens when your muscles aren’t actively moving — say, when your hands are resting in your lap while you watch TV.

“In both diseases, your hand can shake when you’re trying to hold something still and steady. PD tremor usually shows up only on one side of the body at first. ET tremor can also be asymmetric, but usually, there’s at least some tremor in both hands.”

How do you manage essential tremor symptoms?

Though there is no cure for ET or any treatment that stops the disease from progressing, treatment can greatly improve symptoms and enhance quality of life for those living with the condition. Evaluation, diagnosis, and treatment from a neurologist specializing in movement disorders can be lifechanging.

As ET progresses, it can interfere with daily tasks such as eating or shaving. Before it progresses that far, doctors recommend taking steps to manage the condition. Dr. Haq adds, “As soon as ET affects quality of life, it should be treated.”

Lifestyle changes to improve ET symptoms

Stress, exhaustion, excessive caffeine, and extreme temperature changes can trigger or worsen the symptoms of ET. Getting enough sleep and rest while managing emotional stressors can help limit the intensity and frequency of essential tremors.

ET-specific therapeutic exercise and modifications

Physical therapy can strengthen the muscles affected by ET. Some research shows that treatment aimed at enhancing coordination and dexterity helps people with ET perform particular tasks by improving muscle control.

An occupational therapist can teach patients with ET a variety of techniques and tools to make everyday tasks easier. These therapeutic workarounds may include weighted utensils and thicker, heavier writing instruments with rubber grips.

Another option is a noninvasive stimulation device attached to the wrist. Worn like a sports watch, it alternately stimulates two nerves in the forearm. Though short-lasting, the effect could help those with more noticeable symptoms feel more comfortable in certain situations.

Medications for ET

Two medications commonly prescribed to control ET symptoms are beta-blockers, such as propranolol (Inderal), and antiepileptic/anticonvulsants, such as primidone (Mysoline). Beta-blockers are typically prescribed to treat chest pain, lower high blood pressure, and control heart rhythm.

 “A new, emerging therapy for essential tremor is ulixacaltamide, which has shown benefits in people with essential tremor in several clinical trials,” Dr. Luca says. “Unlike the other medications for tremor, this particular calcium-channel blocker acts specifically on tremor circuits. It improves the ability to perform basic simple tasks, like drinking from a cup and writing.”

Non-Surgical, Noninvasive Treatment for ET

Focused Ultrasound (FUS), also known as MRI-guided Focused Ultrasound, uses high-frequency sound waves to target and ablate brain tissue that’s responsible for tremor — without affecting surrounding areas of the brain. “Unlike deep brain simulation, FUS does not require surgery and implantation of wires or a battery,” Dr. Luca explains. “The treatment is performed while the patient is awake, and improvement in symptoms is immediate.”

Deep Brain Stimulation is a surgical option for ET.

If tremors significantly impact a person’s quality of life, they can’t tolerate medication for tremors, and they have no serious medical conditions, they may be a candidate for deep brain stimulation (DBS). With this two-step procedure, neurosurgeons implant a device that works like a pacemaker for the brain. DBS reduces tremor by about 90%, which allows many patients to reduce their ET medication. “Deep brain stimulation can be extraordinarily successful and can be adjusted as the condition progresses,” says Dr. Haq.

Treating essential tremor at UHealth

UHealth’s Division of Movement Disorders is a leader in DBS treatment in South Florida, where physician-researchers conduct clinical trials on devices from the three major DBS manufacturers.

In addition, “We provide a comprehensive evaluation of patients undergoing advanced treatments like deep brain stimulation and focus ultrasound. We use detailed neuropsychological evaluation, screening for memory disorders, and advanced imaging to properly select patients for these advanced treatments,” Dr. Luca says. “This interdisciplinary approach and the expertise of our neurosurgical team has allowed us to produce significant improvement in patients’ quality of life with minimal side effects.”

To schedule an evaluation with UHealth’s neurological specialists, call 305-243-3100.

Written by Dana Kantrowitz. Medically reviewed by UHealth providers Corneliu Luca, M.D., Ph.D., a movement disorders neurologist, and Ihtsham UI Haq, M.D., a neurologist specializing in movement disorders and chief of the Movement Disorders Division.

Originally published on: March 09, 2023

Tags: decrease tremors, deep brain stimulation, Dr. Corneliu Luca, Dr. Ihtsham Haq, focused ultrasound, shaky hands, treatment for essential tremor