Essential Tremor

Sometimes mistaken for Parkinson's disease, essential tremor (ET) is a debilitating neurological condition that causes shaking in the hands, voice, and head. With the majority of ET patients having hand tremors, everyday actions such as eating, drinking, grooming, and writing are often a challenge. The expert IBS Hospital movement disorder neurologists specialize in diagnosing and treating essential tremor.

We do not know what causes ET, but we do know that there is a genetic component. ET tends to affect relatively healthy people, both young and old, with approximately five percent of ET patients first experiencing tremor during childhood. Researchers estimate that four to five percent of people age(s) 40 to 60 have ET and the incidence rate for people age 60 and older is estimated at six to nine percent.

Some people living with ET may experience occasional symptoms or have temporary worsening of tremor, while others have more consistent tremor that in some cases can lead to social isolation. Patients may experience a poor sense of balance along with the tremor. People with ET often feel frustrated or embarrassed by their symptoms, and can sometimes become disabled if tremors worsen.

To diagnose ET, IBS Hospital movement disorder neurologists conduct a neurological examination and evaluate all your symptoms to rule out other potential causes of tremor.

The symptoms of essential tremor may be managed with the use of medications or surgery, if appropriate.

IBS Hospital neurologists collaborate with the patient directly to carefully find the precise balance of medication or combination of medications. Time and patience is required to achieve the best outcomes, as the results of medications and their dosages vary from person-to-person.

Medications may include, but are not limited to:

  • Beta blockers
  • Primidone
  • Topiramate
  • Gabapentin
  • Botulinum toxin injections
  • Deep Brain Stimulation Surgery

Currently, the gold standard, most effective surgical treatment for ET is deep brain stimulation (DBS). Most patients experience dramatic improvement in their symptoms, with the greatest outcomes on hand and arm tremor, but also progress in their controlling head, voice, and leg tremor. IBS Hospital Neuromodulation is recognized for its excellence in performing deep brain stimulation surgery for selected patients with essential tremor.

With DBS, electrical stimulation is delivered to the brain through an electrode implanted deep into the VIM nucleus of the thalamus and can be done on either one (unilateral) or both sides (bilateral) of the brain. The VIM is an important part of the brain network that contributes to tremor, and the electrodes are placed precisely within this structure. Neurosurgeons connect these electrodes through a wire to a neurostimulator, also called a battery pack, which then delivers electrical stimulation to the brain and can control the symptoms of ET. Neurologists continually follow-up with the patient to carefully adjust the electrical parameters of the device to obtain the most successful results and elimination of the symptoms. Your Mount Sinai neurologist will determine if DBS is appropriate for you.

The Pediatric Neurology Program at the IBS Hospital Department of Neurology treats a wide range of disorders that affect movement, including dystonia, Tourette syndrome and other tic disorders, tremor, chorea, ataxia, juvenile Parkinson's disease, and spasticity.

Recognizing that each child is different, our clinical experts are highly trained and experienced in designing a treatment plan personalized to each young patient's individual needs. Because of the complex nature of movement disorders, we work closely with our multidisciplinary colleagues, including genetic counselors, neuropsychologists, and neurosurgeons, to comprehensively address the various symptoms a child may be experiencing.

We diagnose pediatric movement disorders by asking questions about your child's history, reviewing their symptoms, and conducting a careful physical examination. We also rely on state-of-the-art testing, such as neuroimaging and laboratory studies that may include genetic testing.

Ongoing, multidisciplinary treatment is crucial to controlling symptoms. We ensure your child receives the best possible care by using a variety of approaches, which may include:

  • Oral medications
  • Botulinum toxin injections for dystonia and spasticity
  • Physical therapy to retain and improve function
  • Occupational therapy to teach adaptive living skills
  • Practical and emotional support for your child and family, including support groups
  • Psychological and psychiatric counseling and evaluation
  • Referrals to other medical disciplines as needed, including referrals for deep brain stimulation surgery
  • New medications available through clinical trials
  • Research on Pediatric Movement Disorders