Essential Tremor: What it is and how to treat it

August 01, 2012

Do you or someone you know shake when raising a glass of water to drink or have problems writing a check at the grocery store?

If so, essential tremor may be the cause. Essential Tremor (ET) is the most common movement disorder and those suffering from it experience uncontrolled movement , usually of the hands and arms. Over 10 million Americans are diagnosed, yet many people have never heard of it. Some assume shaking is just a sign of aging or they fear they may have Parkinson’s disease. ET differs from Parkinson's in many ways, one being ET is an "action" tremor (more pronounced when trying to complete a task) where a person with Parkinson's has tremors more often at rest and the shaking may actually lessen during activity.

Essential Tremor is caused by overactive cells in the area of the brain called the thalamus. The thalamus is about the size of a walnut and within the brain there are two of them. If there are overactive cells in the right thalamus, the person will have signs of tremor on the left side and vice versa. Some patients suffer from tremor on both sides.

It is important to know Essential Tremor is a treatable condition.

There are three common methods of treatment:

  • Medication: Several medications are used with varying degrees of success. Once diagnosed, medications are usually prescribed first in hopes the patient will tolerate the dose and the tremor can be controlled. Drug therapy may lose effectiveness over time, at which point other options may be considered.
  • Deep Brain Stimulation (DBS): Is a surgical procedure and a great option for many people. Several tiny electrodes are implanted into the brain and a stimulator is attached to the wires under the skin near the collarbone. DBS provides nearly instantaneous relief from tremor in 80% of patients. You can click on this link and watch this short video to learn more about DBS, or watch footage from a DBS procedure that was livestreamed last year.

  • Gamma Knife Thalamotomy: Is a non-surgical treatment using highly focused radiation to kill the cells causing the tremor. Results take several months and like DBS has an 80% success rate.

Watch this video for more information about Gamma Knife:

I would like to invite you to a community presentation I will be giving at Swedish Medical Center in Issaquah on August 15th. I will share additional information about Essential Tremor and Gamma Knife treatment. You can click here to register for this free seminar.


My friend is very interested in gamma knife for his essential tremor. Unfortunately, I already have commitments here in Seattle on the day that you will do a presentation on this subject in Issaquah. There is no way that I can take him to Issaquah to attend your presentation. Will there be a similar presentation here in Seattle sometime soon? If so, we want to attend. Since he lives in Seattle, his gamma knife treatment would be performed here at the Cherry Hill campus, I assume. Thank you so much for your response.
Hi Carla, Thanks for your question!Due to the overwhelming interest in this topic, we are looking at adding additional presentations in Seattle but we have not confirmed any dates. One option for your friend is he can schedule a consultation with Dr Young to discuss his tremor and the Gamma Knife procedure. The Radiosurgery Center�s phone number is 206-320-7130 and it is indeed located at the Swedish Cherry Hill campus. If you prefer to wait for a presentation, please call the same number and ask for me (Erin Kieper), and I can contact you with future presentation dates. Thank you for your interest.
Is this at all related to ortho static tremor
I would like to discuss my options; my RH tremor is becoming more and more troublesome.
Dean and Linda, Dr. Jennifer Witt and Dr. Susie Ro are neurologists who specialize in movement disorder at the Swedish Neuroscience Institute. They would be happy to schedule time to meet with you regarding your questions and situations. Please contact the Movement Disorder Clinic at 206-386-3880.
Hi, myself and my son(17) suffer ET; I am ok and used to live with it but my son may need some treatment. Is this procedure also valid for teens or adults only. Is there a chance it disappears when he becomes older. Is Gamma Knife covered by insurance? we live in Florida.
Alexander, I have treated young adults with Gamma Knife but would consider Deep Brain Stimulation (DBS) as well for your son. Most insurance carriers approve DBS, while some are hesitant to approve Gamma Knife. If you are interested in checking with your insurance, our office can provide you with the CPT and diagnosis codes for you to investigate with your insurance carrier.Unfortunately essential tremor is a progressive disorder which typically worsens over time.If you are interested in further information or would like the list of codes, please call our office at the Swedish Radiosurgery Center 206-320-7187.
I want to explore having the treatment for both left and right side.
Hi John,Many people with essential tremor report shaking on both their left and right limbs. Deep Brain Stimulation and Gamma Knife Thalamotomy can treat both sides but there is a waiting period between the two procedures. Most patients will select to treat their dominant side first but that decision is left up to the individual based on their needs. For additional information, please give us a call and we can answer any questions: 206-320-7187
i am a sixty-eight year-old male in good health and i have had ET since vietnam. Early on it was very slight but over the years has gotten worse. i am on 250 Primidone for several years. And a shot or two of wiskey alcohol has a positive effect in reducing the tremor Will this precedure help? Will it still get worse even if I have the procedure. I live in Ohio
You might be a good candidate for treatment � if interested, please get in touch with us for an evaluation by calling 206-320-7187.
Hello, I have had the shakes in my hands for years. I am a very healthy 49 year old male. It is readily apparent when I am drinking or pouring something. My father, who recently passed at 89 years old, had it real bad and could hardly eat and drink. Other family members also have it. Right now, we control it with a shot of bourbon. It seems to help some. Is this essential tremor? I live in Montana and the rest of the family in Ohio. Should I wait till it gets worse to treat? What is the best remedy? What are the risks and costs? Thank you,Brian
Hi Brian, you can call the program manager, Erin, at 206-320-7187 and she can answer your questions.
why does alcohol reduce ET? My mother reports that the shaking is greatly improved when she has a glass of wine. Why is that?
Many people with essential tremor report a reduction in their tremor when they have an alcoholic beverage. The reason why it is helpful is unknown but it is interesting that when people with essential tremor are asked when they drink, it is usually before dinner.
I am 75 years old and have a tremor on the right hand when I write, drink for 25 years.Is there a prescription you can recommend ? Is 250 primidone efficient.Thank you.
Claude, thank you for your question. Your primary care physician or neurologist would be able to discuss the medication options for controlling your tremor as they know your medical history. Please check with your doctor for their opinion on medication and dosage selection which is best for you.
I am 61 yrs old and have had ET for as long as I can remember. Your Gamma Knife Thalamotomy sounds very promising. I live in S.E. Washington and was wondering what the cost would be? I use cups with lids to drink from and dinner can be frustrating. This is the third time I typed this!Thanks,Marvin
Mr. Clark, thank you for sharing your story and we understand how frustrating tremor can be. Please give us a call (206-320-7187) and we can discuss the treatment options for essential tremor as well as the insurance coverage/cost for Gamma Knife.
Before I begin my research on Gamma Knife for essential tremor, I need to have a range of costs for the procedure including facility and ancillary charges. Thank you.
Hi Larry, you can call the program manager, Erin, at 206-320-7187 and she can answer your questions.
Are there movement clinicss/radiosurgry centers that you are aware of that are located in North Carolina? I live in Charlotte.
We are not familiar with any centers in North Carolina specializing in the Gamma Knife treatment for essential tremor. The International Essential Tremor Foundation (IETF) has a list of movement disorder centers around the country and may be a good resource for you. Their website is . If you would like additional information about the Gamma Knife option, we would be happy to provide the information. Please call us if you are interested at 206-320-7187.
I have been diagnosed with essential tremor called progressive dysphonia of my vocal cords. I have been told that I sound like Katherine Hepburn when I speak. I have tried medications but they don't help. I have also been told that Botox may help. Please advise.
Botox may help. Other treatment options may be available, such as medication, deep brain stimulation or gamma knife, depending on the scope of tremor and other aspects of your health. I would recommend evaluation with a movement disorder specialist.
I live in Florida are there any treatment centers in my state?
Dear Mr. Bocian,Thank you for your inquiry about the Gamma Knife treatment for essential tremor. I am not aware of any centers in Florida specializing in using the Gamma Knife for this condition. If you would like more information about this treatment option, we would be happy to speak with you about it. Our number is 206-320-7187.
Dear doctors, I'm a 27 year old pre-nursing student diagnosed with ET. I started noticing the shaking on my left hand and arm roughly around 10yrs old then diagnosed at 15. And now, at 27 yrs old, its definitely getting worse. My biggest concern is letting my ET become an obstacle or barrier in my career, or just in general my life. Furthermore, I live in California, so are there any Gamma knife treatments over here in the sunshine state? I'm definitely interested in this type of treatment, it's not invasive, 80% success rate, i'm definitely intrigued. Sold! Anyways, thank you so much for your time and hope to hear from you soon :)
I have had essential tremor for several years that caused my head to shake. Could that be treated with one Gamma Knife treatment? I understand that for essential tremors of the limbs one side at a time is treated.
Thank you Shanna for the question. Gamma Knife can be used to treat head tremors. Please give us a call at 206/320-7187 to discuss the details and treatment options.
Hello, I am just wondering about this. My arm and hand have these symptoms and I don't understand. But I am only 26 years old. Can anyone help me?
Hi Frances, you can call the program manager, Erin, at 206-320-7187. She can answer your questions and suggest next steps.
My mother had ET for many years before she passed. I am 69 and have had tremors in my right hand and head for years. They are getting worse. My question>>I am a two time cancer survivor. The first time I had radiation to my breast and 10 years later, chemo and removal of my right lower lobe of the lung. Since Gama Knife is done with radiation, can it be used again to treat ET?
Linda thank you for reaching out, indeed gamma knife can be used to treat essential tremor in this situation.