Why Do My Hands Shake?

I remember the moment essential tremor (ET) first came to my attention. I was about six years old, playing games at a neighbor kid’s birthday party. We were race-walking across the lawn, balancing a row of dried peas on a butter knife. Whoever made it to the finish line with the most peas intact won.

I didn’t make it three steps. As the peas slid off my knife, I heard someone’s mom laugh and say, “Look at her. She’s shaking like a leaf on a tree.”

Embarrassed in front of my friends, I remember thinking, “What a stupid game!” Much later, I learned I had ET, a nervous system disorder that causes involuntary, rhythmic shaking.

About half of the people with ET, including me, have familial tremors caused by an alteration to our DNA. Others have ET for no apparent reason.

“ET is common and usually runs in families,” says Jason Margolesky, M.D., a neurologist specializing in movement disorders at the University of Miami Health System. ET is more common past the age of 40.

“About 4 to 5% of people over age 65 have ET,” says Dr. Margolesky.

Fortunately, ET is not life-threatening, which is why doctors call it benign essential tremor.

The condition can be annoying, however. How often have people asked if I’m nervous when my hands shake? And now and then, a water glass slips through my hands and crashes to the floor. Beyond occasional embarrassment and a few broken glasses, I’m lucky it hasn’t affected me in other ways.

For some people, however, ET is life-altering.

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

“Essential tremor is an isolated tremor disorder. The tremor involves both arms and is the main and often only feature of the condition. While tremor is the most recognizable symptom of Parkinson’s disease, it is much more than a tremor disorder. PD symptoms can include slow movement, muscle stiffness, and changes in walking and balance. There are also ‘non-motor’ symptoms such as sleep disorders, loss of sense of smell, and constipation.

“ET has none of this; just the isolated tremor that can impact the quality of life and activities of daily living,” says Dr. Margolesky.

Ihtsham UI Haq, M.D., a UHealth neurologist specializing in movement disorders and chief of the Movement Disorders Division, offers this example: “ET tremor happens while you do things – when you’re eating or bringing a cup to your mouth. 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 at first. ET tremor can be asymmetric, but usually, there’s at least some tremor in both hands.”

How is ET treated?

ET will progress slowly despite treatment, says Dr. Margolesky. “Treatment can improve the symptoms, but nothing stops the progression of the disease.”

He believes it is important to diagnose ET, especially in children.

“Early on, ET can be confused with Wilson’s disease; in a young person with tremors, it’s important to rule out conditions like Wilson’s disease to prevent worsening.” (Wilson’s disease is a rare genetic disorder that causes copper to accumulate in the organs.)

Regardless of your age, because ET is common and can be confused with more serious diseases such as PD and Wilson’s disease, if you have a chronic tremor, Dr. Margolesky recommends being evaluated by a neurologist specializing in movement disorders. Dr. Haq adds, “ET is treatable, and as soon as it affects the quality of life, it should be.”

How do you manage essential tremor symptoms?

As ET progresses, it can interfere with daily tasks such as eating or shaving. Before it progresses that far, the doctors recommend taking steps to manage the condition:

Lifestyle

Stress, exhaustion, excessive caffeine, and extreme temperature changes can affect ET. Avoiding these situations helps regulate the condition. “Tremors respond to everything going on in the body, whether it’s stress, fatigue, pain or something else,” Dr. Margolesky says.

Therapeutic exercise and modifications

Physical therapy strengthens the muscles affected by ET. Some research shows that treatment aimed at improving coordination and dexterity helps the condition. “It doesn’t necessarily calm the tremor itself, but helps when performing a particular task,” Dr. Margolesky says.

Occupational therapy helps people work around their symptoms by teaching them to use weighted utensils and thicker, heavier writing instruments with rubber grips. ET, Dr. Margolesky says, is a nuanced condition that is different for everybody.

“It takes a lot of trial and error to find what works, so it’s nice to have an expert occupational therapist run through the options with you.”

Another option is the FDA-cleared Cala Trio device. Worn like a sports watch, it alternately stimulates two nerves in your forearm.

“You wear it for 40 minutes, and the effect lasts about an hour,” Dr. Margolesky says.

Though short-lasting, the effect could help those with more noticeable symptoms get through a job interview or social dinner more comfortably.

Medication

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. Several new drugs to treat tremors are currently being tested in clinical trials.

Surgery

“Deep brain stimulation (DBS) can be extraordinarily successful in patients for whom medication doesn’t do enough and can be adjusted as the condition progresses,” says Dr. Haq. 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 DBS.

I’ve learned to live with ET; in fact, I tend to forget it most of the time. Since I make my living working with my hands, I’m grateful that, thus far, my condition is mild. Should things change, I’m glad to know that help is available.

To schedule an evaluation, call 305-243-3100.

Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: decrease tremors, Dr. Ihtsham Haq, Dr. Jason Margolesky, shaking or trembling, shaky hands, symptoms of essential tremor