What’s the difference between an essential tremor and Parkinson’s?

DEAR DOCTOR K:

My father was recently diagnosed with essential tremor. Is this the same thing as Parkinson’s disease? If not, what is the difference?

DEAR READER:

Essential tremor is a brain condition that causes tremors: uncontrollable shaky movements of the hands, limbs, head or voice. It is usually mild and is very common, often running in families. It usually starts later in life, but when it runs in families it can start in young adulthood.

In contrast, Parkinson’s disease is a serious neurological condition that also causes a tremor. It is much less common than essential tremor. Parkinson’s disease also can cause severe difficulty with walking and most movements of the arms and hands, and can be accompanied by dementia.

Essential tremor is an aggravation that occasionally interferes with a person’s life. When the symptoms of essential tremor first appear, many people understandably worry that they may be getting Parkinson’s disease.

How are the tremors that are seen in essential tremor and in Parkinson’s disease different? Essential tremor usually involves the shaking of one or both hands or the head. The shaking is not always dramatic. Essential tremor is most noticeable when the body is in action, as when you are writing, typing or pouring a beverage. It is less prominent or absent at rest.

In contrast, Parkinson’s tremors are more noticeable at rest. The hands of people with Parkinson’s shake when they are resting. But when they reach out to grab or hold something, such as a cup of coffee, the shaking stops.

Essential tremor is a permanent condition that typically worsens over time. It may gradually spread from one part of your body to other parts. Most people experience only mild or moderate symptoms, but in others, it can cause substantial disability. A patient of mine who was an electrician developed essential tremor in his early 60s and became unable to work. The great actress Katherine Hepburn developed essential tremor that affected her head, hands and voice. She hated it, but her skill as an actress was undiminished.

Medicines called beta-blockers (often used to treat high blood pressure) are the most effective treatment for essential tremor. Beta-blockers usually improve the tremor so that it doesn’t interfere with normal activities. In some people, the tremor disappears completely.

Other drugs that may help include the anti-seizure drugs primidone (Myidone, Mysoline) and gabapentin (Neurontin), and the anti-anxiety medicine lorazepam (Ativan).

Stress and caffeine may make the tremor worse. Drinking small amounts of alcohol may temporarily relieve the tremor.

Certain medicines may also worsen your father’s tremor. They include stimulants, lithium, some antidepressants and thyroid hormone. Have your father talk to his doctor if any of these medications could be worsening his symptoms.