Essential Tremor

What is essential tremor?

Essential tremor is a neurological disorder that causes involuntary, rhythmic movements that get worse with activity. While it can occur in any part of the body, it often affects the arms and hands.

The condition tends to affect members of the same family. The tremor of essential tremor often improves with alcohol, although we don’t recommend using alcohol as a treatment.

Essential tremor symptoms

Patients diagnosed with essential tremor may also experience the following:

• Involuntary movements that often involve the wrist and fingers, creating the appearance of hand flapping. They may also affect the head, face, mouth and tongue.
• Symptoms become progressive and disabling that worsen as patient ages
• Symptoms worsen with activity, stop at rest and can improve with alcohol

Treatment options for essential tremor at UCLA

If you've been diagnosed with essential tremor, your doctor will first prescribe medication. Not all medications are appropriate for all patients. If first line medications (Primidone and Propranolol) fail to adequately control your tremor, your doctor may consider recommending either MRgFUS, deep brain stimulation, or radiosurgical thalamotomy. At the UCLA Neuromodulation for Movement Disorders Program, we offer the following treatment options:

• Medical treatments: prescribed medications (Beta Blockers, Anticonvulsants, Benzodiazepines), local injections of botulinum toxin (BTX).
• Non-Invasive MR Guided Focused Ultrasound (MRgFUS): uses high intensity focused ultrasound waves to heat up a precise target in the brain. UCLA is the only hospital in Southern California that offers non-invasive treatment for Essential Tremor.
• Deep Brain Stimulation (DBS): Implants electrodes, or wires, deep inside the brain to change irregular brain activity.
• Stereotactic Radiosurgery (radiosurgical thalamotomy): Delivers high focal radiation on a targeted area of the brain.

What to Expect During Consultation for Essential Tremor

There are multiple goals for your consultation for essential tremor, including:

1. Confirming your diagnosis of essential tremor
   • Many disorders can cause tremor, so the diagnosis can sometimes be confusing.
   • To understand if your tremor is indeed due to essential tremor, we will ask you several questions, including but not limited to, the history of your tremor, whether your tremor bothers your more at rest or with movement, whether you have a family history of tremor, whether your tremor improves with alcohol, and several additional questions.
2. Evaluate your past treatments for tremor
   • In many cases, medications can provide significant relief of tremor.
   • First line medications include propranalol and primidone. If you haven't yet tried these, we may recommend a trial of these medications before considering a surgical therapy. In some cases, these medications may help but your tremor may still be incapacitating or bothersome. In these cases, we may still recommend treatment with MR Guided Focused Ultrasound (MRgFUS), Deep Brain Stimulation (DBS), or Stereotactic Radiosurgery.
3. Document the severity of your tremor
   • Best clinical practice is to provide detailed clinical documentation of your tremor and how it impacts your quality of life.
   • We will administer a standard rating scale, which will include a physical examination of your tremor, tests of your writing and drawing, and finally questions about how your tremor impacts your quality of life.
4. Understand how your tremor impacts your life and how treating your tremor will improve your life
   • In addition to asking standardized questions, we want to get to know you and understand your personal and individualized goals, to make sure that the treatments we offer can help you in a meaningful way.

Once we recommend a treatment, we will discuss in detail the expectations from the procedure, including both benefits and risks. We will also review the procedure for making sure you're a candidate for the procedure (which will require a specialized CT scan) and for scheduling your treatment.