Essential Tremor: It Isn't Parkinson's
It's called "Essential Tremor," but when it first started both Jerry Macklin and his family thought he had Parkinson's Disease.
For Jerry it started in his hands. When he was completely relaxed he was fine. When he tried to lift a cup or reach out for something, his hands shook. His handwriting deteriorated to the point of illegibility. He now uses a keyboard to write. Buttoning a shirt and tying his shoes are frustrating because of his tremor.
While Parkinson's Disease is best known for causing an involuntary tremor, essential tremor is actually more common. It usually develops slowly after about age 40, and ultimately up to 20% of people over the age of 65 may have some degree of tremor. It most often affects the arms and hands, but it can also extend to the head and the lower extremities. It can also less commonly affects the head, the tongue and the voice (larynx).
In approximately 50% of cases there appears to be a family history of essential tremor. Experts haven't yet reached any conclusions about why the other 50% of patients develop symptoms.
Katherine Hepburn is often used as a model for essential tremor. Recollect her tremulous voice and the persistent involuntary movement of her head, particularly during her performance in "On Golden Pond." These are classic symptoms of essential tremor that has affected the head and voice. She never appeared to have any difficulty walking. Ms. Hepburn did not have Parkinson's Disease, and despite her "disability," she was able to perform for many, many years.
This is not to imply that essential tremor is not debilitating. It can become quite debilitating if tremors worsen significantly over time. This is why medical experts now tend to avoid the term "Benign Essential Tremor," which used to be popular. There is nothing "benign" about a tremor that can make it difficult to manage many day to day activities.
Parkinson's Disease treatment is quite different from the treatment for essential tremor, so it is important to have an accurate diagnosis. The prognosis for essential tremor is also less dire, as it does not on its own usually lead to the severe balance problems, cognitive decline or behavioral problems that often accompany Parkinson's Disease. While Parkinson's Disease is a "disease," essential tremor is classified as a "movement disorder."
While severe cases of essential tremor can be treated with medication, most of the medications now in use can produce undesirable side effects, so many physicians prefer to be cautious with prescriptions. Many patients never take medication specifically for their tremor. If symptoms become severe, beta blockers and anti-seizure medications have proven to be useful for some patients. Less frequently, deep brain surgery and deep brain stimulation have both successfully reduced extremely debilitating tremors. Most people with essential tremor never need these kinds of invasive surgery.
Parkinson's Disease gets all the press, so when our loved ones develop a tremor we do tend to immediately think "Parkinson's." Because tremor can be caused by several things, including heavy metal poisoning (primarily lead or mercury), medication side effects, thyroid disease, as well as other neurological problems including Parkinson's Disease, don't jump to conclusions. A complete and thorough neurological examination and "differential diagnosis" may give you better news.
If the ultimate diagnosis is Parkinson's Disease, then it is important to begin treatment. If the ultimate diagnosis is that the tremor is a side effect of something manageable, then making changes can often reduce or eliminate the tremor. If the final diagnosis is essential tremor, then there is no need to initiate drug treatment directed toward Parkinson's Disease.
Your long-term care planning will hinge in many ways on the results of an in-depth neurological evaluation and expert diagnosis/treatment.
While we have ultimate respect for primary care physicians and all they can and do do well, this is something that should be diagnosed by a neurological specialist. If your doctor or you suspect Parkinson's Disease because your senior has a tremor, make an appointment for further testing. The odds are good that it isn't Parkinson's Disease.
The following organizations support those with essential tremor and other movement disorders:
International Essential Tremor Foundation
National Ataxia Foundation (NAF)
Tremor Action Network
WE MOVE (Worldwide Education & Awareness for Movement Disorders)