Essential Tremor Vs Parkinson’s Tremors: A Guide To The Major Differences
When people think of Parkinson’sdisease, they may picture the shaking hands commonly associated with thecondition. Persistent shaking of hands and limbsalso known as tremorcan makeit difficult to write a grocery list, hold a cup of tea, button a shirt andapply makeup, among other routine tasks. When tremors interfere with dailylife, it can be very disruptive. While tremors are a hallmark of Parkinson’spatients, there are other diseases similar to Parkinson’s that can causetremors.
Essential Tremor Vs Parkinsons Disease
Essential tremor and Parkinsons disease are both adult-onset tremor disorders that can be characterized by shaking that affects daily life. If you have one of these conditions, you may find it difficult to hold onto items, struggle to write normally, and notice your hands shaking uncontrollably. However, beyond that, there are many key differences.
If you believe you may suffer from one of these conditions, this guide can help you better understand the signs that you may have Parkinsons disease or essential tremor, how each is diagnosed, and what the treatment process entails. If you have questions about a certain aspect of these conditions, use the links below to navigate to its specific section:
Diagnostic Criteria For Et & Pd
Two sets of criteria are commonly used for the diagnosis of ET. For definite ET, the diagnostic criteria proposed by the Movement Disorder Society require the presence of persistent, bilateral postural tremor of the forearms . Kinetic tremor may be present, but is not necessary for the diagnosis . No other abnormal neurological signs may be present, except for Froments sign, which is a cogwheel phenomenon without rigidity . For definite ET, the criteria proposed by the Washington Heights-Inwood Genetic Study of Essential Tremor require the presence of moderate amplitude postural tremor as well as kinetic tremor, with the latter resulting in impairment of activities of daily living .
The UK Parkinsons Disease Society Brain Bank criteria require postmortem confirmation for the diagnosis of definite PD . The diagnosis of probable PD requires bradykinesia and one of the following additional features: rigidity, 46-Hz rest tremor or postural instability . In addition, three supportive features are required . The National Institute of Neurological Disorders and Stroke criteria for PD only include clinical criteria for possible PD, which require three out of four of the following features: rest tremor, bradykinesia, rigidity or asymmetric onset .
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Treatments For Parkinsons Disease
While currently available Parkinsons treatments cannot slow or halt the disease, they can help manage symptoms. According to the American Parkinson Disease Association, here are some of the most common treatment options:
There are also lifestyle changes that you can make to help with your Parkinsons symptoms, including:
- Practicing strength training to help with movement
- Stretching to help with rigidity
- Getting massages to relieve muscle stiffness and stress
- Eating a healthier diet to help with lethargy
While these are the most commonly recommended treatment options for Parkinsons disease right now, there is a lot of effort and financial support toward finding new solutions, including clinical trials of medications.
Misperception #: Jaw Tremor = Pd
Jaw tremor is a type of cranial tremor that is classically associated with PD. It typically occurs when the mouth is closed . However, jaw tremor can also occur in ET cases. One study evaluated jaw tremor in ET and found a prevalence of 8% in a population-based sample, 10% in a tertiary referral sample and 18% in a brain repository sample . The jaw tremor was predominantly a postural tremor or kinetic tremor . Jaw tremor, was associated with older age, increased severity of arm tremor and the presence of head and voice tremor . Jaw tremor was also more frequently associated with rest tremor of the arms , which raises the possibility of the future development of PD in those patients.
Clinical pearl #5: Jaw tremor may occur in either ET or PD, although in ET it is more typically a postural or kinetic tremor rather than a rest tremor.
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What Are The Different Categories Or Types Of Tremor
Tremor is most commonly classified by its appearance and cause or origin. There are more than 20 types of tremor. Some of the most common forms of tremor include:
Essential tremor
Essential tremor is one of the most common movement disorders. The exact cause of essential tremor is unknown. For some people this tremor is mild and remains stable for many years. The tremor usually appears on both sides of the body, but is often noticed more in the dominant hand because it is an action tremor.
The key feature of essential tremor is a tremor in both hands and arms, which is present during action and when standing still. Additional symptoms may include head tremor without abnormal posturing of the head and a shaking or quivering sound to the voice if the tremor affects the voice box. The action tremor in both hands in essential tremor can lead to problems with writing, drawing, drinking from a cup, or using tools or a computer.
Tremor frequency may decrease as the person ages, but the severity may increase, affecting the persons ability to perform certain tasks or activities of daily living. Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may trigger tremor and/or increase its severity. Though the tremor can start at any age, it most often appears for the first time during adolescence or in middle age . Small amounts of alcohol may help decrease essential tremor, but the mechanism behind this is unknown.
Dystonic tremor
Cerebellar tremor
Who Is Affected By Essential Tremor
Up to 10 million Americans are estimated to have essential tremor 10 times the number of people with Parkinsons disease. ET affects males and females equally across a multiracial population. Individuals with a clear family history of tremor are at greater likelihood of developing ET. However, it can occur in individuals without a clear family history. While it can start at any age, onset is most common in middle age.
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Recommendation For Those With Et
ET, PD and parkinsonism have one thing in common: they dont affect individuals in identical ways. There are accepted diagnostic guidelines, but an infinite number of small or large differences can occur: rate of progression, response to medication, nature of lifestyle problems and impairment, etc. If two persons with ET were to compare notes, they would quickly find that things like propranolol helps one but not the other, or one of them gets terrible restless leg syndrome at night while the other has never had it, etc. Thus, there is a growing theory that ET is not a single disorder, but a group of disorders.
For those with ET who notice that they have additional symptoms that dont fit the classic ET descriptions in books or websites, we recommend discussing the situation with a movement disorder specialist. Perhaps theres no cause for concern, but it may be worth seeking an evaluation to rule out a co-occurring form of parkinsonism. Accurate information may be your best friend, since it both equips you and your doctor to strategize treatment, and also to manage anxiety and gain peace of mind.
iRajput AH, Rajput EF, Bocking SM, Auer RN, Rajput A. Parkinsonism in essential tremor cases: A clinicopathological study. Mov Disord. 2019 Jun 10. https://www.ncbi.nlm.nih.gov/pubmed/31180613iiTarakad A, Jankovic J. Essential tremor and Parkinsons disease: exploring the relationship. Tremor Other Hyperkinet Mov. 2018 8:589.iiiIbid.
What Are The Results
Successful DBS is related to 1) appropriate patient selection, 2) appropriate selection of the brain area for stimulation, 3) precise positioning of the electrode during surgery, and 4) experienced programming and medication management. DBS for essential tremor may significantly reduce hand tremor in 60% to 90% of patients and may improve head and voice tremor.
Patients report other benefits of DBS. For example, better sleep, more involvement in physical activity, and improved quality of life.
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A Tremor In The Lips Jaw Or Tongue May Be An Early Sign Of Parkinson’s
The development of a tremor is one of the most common symptoms of Parkinson’s disease, affecting roughly 80 percent of PD patients. These tremors frequently occur in the hands, feet, or legs, and they tend to develop asymmetrically on just one side of the body.
However, there’s a lesser known part of the body that can also become affected by Parkinson’s tremors, according to the American Parkinson Disease Association . The public charity’s experts say that “slow, rhythmic” tremors in the jaw, chin, mouth, or tongue may suggest a Parkinson’s diagnosis.
Who Is Affected By Tremor
About 70% of people with Parkinsons experience a tremor at some point in the disease. Tremor appears to be slightly less common in younger people with PD, though it is still one of the most troublesome symptoms. People with resting tremor usually have a more slowly progressing course of illness than people without tremor.
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Can Something Be Done About Voice Tremor
Botulinum toxin injections are generally the most effective treatment for voice tremor. Deep brain stimulation using bilateral stimulation may also help voice tremors, but will often cause slurred speech as well. For those with essential tremor, DBS is most often placed unilaterally , at least initially.
Chou, K, Grube, S, Patil, P. Deep Brain Stimulation. A New Life for People with Parkinsons Dystonia, and Essential Tremor. New York: Demos Medical Publishing, 2012.International Essential Tremor Foundation. . ET vs. Parkinsons: How do they differ? Retrieved January 15, 2015, from National Institute of Neurological Disorders and Stroke. . Tremor Fact Sheet. My head shakes: is it dystonia? .
How Can You Tell The Difference Between Essential Tremor And Parkinsons Disease
Essential tremor is a neurological disorder that causes tremors, generally of both hands, but also the head and voice. It is often confused with Parkinsons disease, but the tremor in essential tremor is an action tremor, which means that the tremor is most noticeable when the limb is in use or moving and improves when the limb is at rest. This is opposite of the tremor seen in Parkinsons disease, which is most noticeable when the limbs are relaxed and at rest, and lessens when the affected limb is in use.
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Pd Tremors Only Occur When You’re At Rest
Not all tremors are due to Parkinson’smany have other underlying causes. One way to help distinguish between a PD tremor and something else is that those associated with Parkinson’s are “resting tremors”meaning they only occur when that body part is otherwise inactive.
“The tremor appears as a shaking movement when the muscles are relaxed and not being focused on taking action,” explains the APDA. If your tremor continues despite intentional movement of that body part, there’s likely another explanation. For this reason, many PD patients with a jaw, mouth, or tongue tremor manage this symptom by chewing gum throughout the day.
Symptoms Of Essential Tremor
The primary symptom of essential tremor is involuntary, rhythmic shaking. This tremor can affect any part of the body, though the disorder typically occurs most often in the hands and arms. These symptoms can potentially progress to the voice and head, though for many people the symptoms are relegated to mild tremors in the hands and arms. When it does spread to the head, a head tremor may manifest as no-no or yes-yes nodding.
Essential tremor begins slowly and usually affects one side of the body. The tremor also gets worse when you move. Tremors can also get aggravated by caffeine, fatigue, extreme temperatures, or emotional distress.
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What Treatments Are Available
Treatment depends on the symptoms and extent of disability caused by the tremor. If the tremor is mild, lifestyle adjustments may be all that are needed. As the condition progresses, medications or surgery can be used to relieve the symptoms.
Lifestyle changes
Caffeine and stress should be avoided, and good sleep is recommended. Your doctor may recommend physical therapy, which can improve your muscle strength. Adaptive devices, including wide-grip pens and eating utensils, may help you compensate for your tremor. Alcohol, used in moderation, can reduce tremor for short periods of time.
Medications
Your doctor may prescribe certain drugs or injections to help reduce the tremors. These include, but are not limited to:
- Propranolol, a beta-blocker that is primarily used to treat high blood pressure
- Anti-seizure medications, including primidone, gabapentin, and topiramate
- Anti-anxiety medications, including clonazepam, diazepam, lorazepam, and alprazolam
- Botulinum toxin injections for head and voice tremors
Surgical treatments
The goal of surgery is to reduce symptoms by modifying the abnormal signals that cause the tremor. This can be done with deep brain stimulation or with radiosurgery.
DBS surgery involves implanting electrodes within the brain and connecting them to a stimulator device that resembles a pacemaker. The stimulator delivers electrical pulses to regulate brain activity. Radiosurgery creates a small, permanent lesion in the brain without a permanent implant.
Surgical Treatment For Essential Tremor
When the tremor does not respond well to medications, or severe symptoms impair an individuals quality of life, then surgical treatment can be considered. The two main surgical treatments are deep brain stimulation and focused ultrasound .
DBS involves implanting a thin wire into the brain, which is attached to a pulse generator battery in the chest wall. The stimulator can then send an electrical signal to the area of the brain that controls the tremor, similar to a pacemaker for heart conditions. The stimulation acts as a way to block the messages from your brain that cause the tremor. It has been shown to be very effective in providing relief for some patients and improving their ability to perform daily activities. DBS is a commonly used surgical approach for ET because it is effective, can treat tremors on both sides of the body, has relatively low risk and its effects are reversible.
FUS involves placing a small, precisely targeted lesion in the brain region associated with tremor. Unlike DBS, FUS does not require implanted hardware or even a skin incision, because the ultrasound energy can be delivered through the skin and skull into the brain with MRI guidance . FUS is a single-day, outpatient procedure and can result in immediate and long-lasting improvements in tremor. FUS can significantly reduce tremors on one side of the body, but is not typically used to treat tremors on both sides.
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About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Neurosurgery Associates.
Parkinson’s Disease Vs Essential Tremor Early Symptoms How They Differ
As many as one million Americans currently live with Parkinson’s disease and approximately 60,000 Americans are diagnosed each year. Around the world, more than 10 million people worldwide are living with the disease, according to the Parkinsons Disease Foundation.
A new study published in the journal Brain has shed new light on the genetics behind essential tremor, which is frequently misdiagnosed as Parkinson’s disease. Understanding the differences between both diseases is key to reducing the prevalence of medical mistakes. Heres everything you need to know about both diseases.
Researchers are examining the genetics behind how essential tremor affects the body.Photo courtesy of Simon Gerard
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Misperception #: Bradykinesia = Pd
Bradykinesia is a cardinal sign of PD. Although bradykinesia is not traditionally associated with ET, there have been several studies that report the contrary. One study quantified rapid alternating pronation-supination movements in 10 ET cases, 20 mild to moderate PD cases and 10 controls . Post hoc analysis demonstrated that rapid alternating movement cycle duration was statistically longer in ET cases compared with controls, and similar to PD cases . Another study, involving 61 ET cases and 122 controls, evaluated performance in four timed tests involving hand movements, as well as walking and visual reaction time . ET cases compared with controls had longer mean finger tapping times and mean visual reaction times . Another study reported reduced arm swing in 18/136 clinically diagnosed ET cases . While a small proportion of ET cases may exhibit slower movement times than controls, a reduction in amplitude and cessation of movement during rapid successive movements has not been demonstrated in ET.
Clinical pearl #6: Slower movement times may be observed in some patients with ET, yet other features of bradykinesia have not been demonstrated in ET.
How Is Tremor Diagnosed
Tremor is diagnosed based on a physical and neurological examination and an individuals medical history. During the physical evaluation, a doctor will assess the tremor based on:
- whether the tremor occurs when the muscles are at rest or in action
- the location of the tremor on the body
- the appearance of the tremor .
The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain.
Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup. Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.
The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.
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