Symptoms of essential tremor usually begin mildly but often progress (worsen) over time. The tremors almost always occur in the hands first, and then can move to the head, neck, and legs. Some patients can even have severe voice tremor, where they often sound upset or can be hard to understand because the tremor in their vocal cords is so severe that it makes proper speech difficult. Stress, fatigue, caffeine, low blood sugar, medications, and fluctuations in body temperature can exacerbate the symptoms.
Differences between essential tremor and Parkinson’s disease:
Timing: Essential tremors occur more frequently when moving the hands and arms, while there is little to no tremor at rest. (Some patients may appear to have a tremor at rest, but it is not truly a rest tremor; they are contracting muscles to hold the arm in position, and this can trigger tremor.) With Parkinson’s disease, tremors occur while resting and generally are not substantially worse with movement (although some patients can have elements of both diseases).
Affected body parts: Essential tremors can occur in the hands, voice, and legs. Tremors from Parkinson’s usually occur in the hands and legs but is less common in the head, and voice tremors are rare (although Parkinson’s disease patients can have other types of speech problems).
Linked conditions: Essential tremor remains an isolated condition and usually has no other major symptoms. However, Parkinson’s disease is associated with other problems such as muscle stiffness, slowness of movement, shuffling gait, or stooped posture.
Inheritance: Essential tremor can be frequently, but not always, found in families, with affected patients having close relatives (parent, sibling, etc.) who also had the disorder.
Since essential tremor is often misdiagnosed, anyone experiencing neurological symptoms should be evaluated by a skilled neurologist or neurosurgeon. Medication can be helpful in managing symptoms in the early stages. (See Diagnosing and Treating Essential Tremor.)
The Movement Disorders service of Weill Cornell Medicine Neurological Surgery is a leader in the diagnosis and treatment of essential tremor. Led by pioneering researcher and neurosurgeon Michael Kaplitt, M.D., Ph.D., the Movement Disorder service provides state-of-the-art options for essential tremor treatment, including minimally invasive deep brain stimulation surgery. (See Surgery for Essential Tremor.)
Reviewed by Michael Kaplitt, MD, PhD
Last reviewed/last updated: August 2021