Essential Tremor

Essential Tremor is a movement disorder characterised by uncontrollable shaking, or ‘tremors’, in different parts and on different sides of the body. Common areas affected are the head, larynx, tongue, chin, arms and hands. The lower body is rarely affected. Essential Tremor is more common than Parkinson’s: in the UK population of 64 million, research suggests that up to one million people have Essential Tremor.¹

The exact cause of Essential Tremor is unknown but it is thought that there is a change within the thalamus overtime. The thalamus is a structure within the brain that coordinates and controls muscle activity. Majority of cases are genetically inherited and occur more commonly in the elderly.

Symptoms can vary person to person. If it is interfering with daily activities, you should speak with your doctor and can ask for a referral to a specialist movement disorder team.

• Shaking that cannot be controlled and may occur for just brief periods of time 
• Shaking voice 
• Nodding head 
• Tremors that worsen during periods of emotional stress 
• Tremors that get worse with on-action, such as when you pick up a cup of tea 
• Tremors that lessen with rest 
• Balance problems (in rare cases)

If you have been diagnosed with Essential Tremor (ET) you have options beyond just medication.

There are different types of medicines that can be taken for Essential Tremor. The medicine may be able to reduce the severity of the tremor. Speak to your specialist team about the potential treatments to create an individualised therapy.

Physical therapy to improve coordination and muscle control can be beneficial. To be accepted for DBS surgery, your specialist team will advise you to be aerobically fit as you can be.

For patients with Essential Tremor who do not respond to medications, advanced care options such as MR-guided focused ultrasound (MRgFUS) or DBS may be considered. 

• This incisionless treatment uses focused ultrasound waves to target and ablate the brain tissue responsible for tremors, providing significant tremor reduction. Candidates for this treatment are typically those with severe, medication-resistant tremors.

• Deep Brain Stimulation is a safe and proven medical treatment for Essential Tremor when medication alone is not effective. Unlike other surgical therapies, DBS is reversible, adjustable, and does not destroy tissue.
• DBS procedure is designed to help control motor symptoms while allowing for a reduction in medication. It uses a device similar in size and shape to a cardiac pacemaker and sends signals to your brain to help control the symptoms of movement disorders. In most hospitals, under general anesthesia, your surgeon will place one or two wires called ‘leads’ in the brain.
• The leads are then connected to the stimulator and the stimulator is placed under the skin in the chest or in the abdomen. Paediatric patients often will have the stimulator inserted in the abdomen. When the stimulator is turned on, it produces mild electrical impulses that stimulate a specific target within the brain.
• The stimulation may help regulate the incorrect signaling in the brain, improving some of the symptoms of movement disorders. For many people, daily activities which had been impossible to perform previously could become feasible again.

• Always speak to your clinician to see if this could be a treatment for you. 
• To be accepted for DBS surgery, your specialist team will advise you to be aerobically fit as you can be.

• Most likely, your tremor gradually appeared and has worsened over time. What started as involuntary shaking in your hands, head, and voice is now making simple tasks more difficult.

Medication is not enough.

• If you were prescribed medication upon diagnosis, you may notice that its effects are diminishing. Plus, 30-50% of Essential Tremor patients may not even respond to medical therapy.²

DBS is a proven and safe therapy.

• Unlike other interventional therapies used to treat Essential Tremor, DBS is reversible, adjustable and does not ablate or destroy tissue.

DBS delivers results

Essential Tremor (ET) may only be a nuisance at this point. It might be something you treat with medication or other therapies. But, as your symptoms progress, there may be a time when you notice your medication becoming less effective. This is your window for DBS, which relies on acting during the window when medications begin to become less effective, but haven’t fully stopped working.

Keep up to date with all the research and resources going on to support people living with Tremor. To increase awareness and understanding, Boston Scientific actively participates in community education and builds strong relationships with the local Essential Tremor community.