treatment of essential tremor

Treatment Of Hand Tremors

Do you have shaky hands? Do they shake involuntarily, or is it another body part that trembles? You may have what is called essential tremor. You are not alone. There are about 10 million people in the United States who have hand tremors.

The most common hand tremor is called essential tremor and is often confused with Parkinson’s disease.

If you are concerned about tremors in your hands, you should consult a healthcare professional to determine the cause.

There are several other types of tremors that you can read about here.

If you have moderate symptoms, you may not need any treatment. However, if your tremors make working, eating, writing, or caring for yourself difficult. Then one of the treatment methods listed below may help you.

As for a cure, there is none available for essential tremor or for many other types of tremor.

Determining your treatment will require a proper diagnosis of your condition. Treatment of hand tremors can aid in reducing the hand tremor symptoms.

When a hidden health condition causes your tremors, the tremors can often be improved or even removed entirely once you have a correct diagnosis and treatment


  • A hyperactive thyroid can cause tremors, but once treated, your hands can return to their normal state of steadiness.
  • Medication-induced tremors --you can clear-up the symptoms if you stop using or reduce the dosage of the tremor-causing drug (be sure to consult your physician before changing your medication)

If your doctor can find no other cause for your hand tremors, the following treatments may be an option.

Lifestyle adjustments

Sometimes hand tremors impact your daily activities. Adjusting your routine can help reduce your hand tremor symptoms.


Start with simple steps first:

  • Stay away from caffeine. Caffeine, along with other stimulants, can make your tremors worse.
  • Take steps to manage your stress effectively.

Anxiety and stress tend to make your tremors worse. Although eliminating all stress is impossible, learning skills to handle your reaction in stressful circumstances can go a long way to relieve your tremor symptoms. Sometimes a combination of methods such as meditation and massage works well.

Adapting to constant hand tremors is stressful. You may feel like everyone is watching you, which will only increase your stress and make your tremor worse. The thought of social embarrassment can make you anxious too. That is why learning relaxation techniques, and frankly, not worrying about what other people think is so important.

Tremor management tips:

Observe your tremors throughout the day; sometimes, your hands will shake worse at different times of the day. Be thoughtful as you plan your daily tasks, so you are at your most steady when doing things that require finesse.

Use heavier or larger utensils, or add wrist weights when eating. The added size and weight can even out the tremors giving you better control

Travel mugs and drinking straws are terrific if you have trouble holding your ordinary coffee mug or drinking glass steady.

Adapt your clothing and change from buttons to Velcro or hook style buttons. It is easy to do and will make dressing and undressing much easier.

Slip-on shoes eliminate the frustration of tying laces, and there are many stylish brands available.

Use technology to your advantage, like speech recognition software on your computers and voice-activated commands on your smartphone. Smartphones also have an option to make icons for apps larger and more comfortable to touch with a shaking finger.

Identify the tasks that are most difficult and look for better options. If you have always paid the bills by writing individual checks, switch to an online banking solution with automated bill payment, and start using a debit card instead of writing checks at the store. (people in line behind you will be glad you made the switch too:)

Alcohol can help improve tremors temporarily. Of course, if this is your number one treatment option, you will be restricted from driving, and most employers probably will not support your choice. If you go down this path, you will also note that more substantial amounts of alcohol will be needed to get the required relief from tremors. Medicating with alcohol will soon start to look a lot like alcoholism.

Your neurologist will probably recommend changes to your lifestyle first, followed by medications. Let’s take a look at those next.

Medication for hand tremors

Tremor severity is one of the chief factors in determining your treatment. Various treatments range from doing nothing at all to medications and several types of brain surgery.

Beta-blockers are a front line hand tremor medication.

    • Propranolol is a blood pressure drug that often controls or even removes tremors.
    • The side effects, however, can leave you feeling fatigued and lightheaded.
    • If you have asthma, realize that beta-blockers usually make it worse, so be sure to discuss it with your doctor.

Anti-seizure medications can help some people who do not get relief from beta-blockers.

    • These are a more aggressive class of drugs that neurologists prescribe for epileptic seizures, and other severe neurological disorders.
    • Examples are: Primidone, topiramate, and gabapentin. 
    • Be aware that some anti-seizure medications can cause tremors.

Tranquilizers can be used to help certain people with tremors. Sleepiness, combined with a lack of coordination and concentration, can be a common unwanted side effect, which limits their usefulness.

    • You can’t safely operate a vehicle and are often unable to work or go to school while taking tranquilizers.
    • Long-term use of sedatives can cause physical dependence and severe symptoms of withdrawal if you suddenly stop taking them.
    • Commonly prescribed tranquilizers are clonazepam and alprazolam.

Botulinum toxin, also known as Botox injections, can be used to treat many different types of tremors.

    • Botox injections are effective for about three months per treatment.
    • Head tremors benefit most commonly, and doctors frequently use it for dystonic tremors.
    • Side effects are muscle weakness, especially in your hands and wrists if you use it for hand tremors.
    • When used for vocal tremors, it can result in a raspy voice and make swallowing difficult.

Side effects for medications can vary in extremes, from mere drowsiness to depression and suicidal thoughts. Please be sure to read all of the drug side-effects literature your pharmacist gives you.

It’s a good idea for you and someone close to you to know all of the possible drug side effects. Your friend or family member may need to call a doctor on your behalf, especially if you are experiencing some of the more extreme side effects.

Prescribed medicines are intended to give you positive results. Note that reducing your tremors by 50% will be considered a good result by most medical professionals.

Surgery for tremors

When medication doesn’t improve your hand tremors or causes undesirable side effects, surgery might be an option. There are surgical treatments like deep brain stimulation, and others that target the area of the brain that generates the essential tremor.

Doctors are likely to recommend surgery when:

    1. All other efforts to reduce your tremors have failed.
    2. Your shaking is so disabling that surgery appears to be the best option.


Deep Brain Stimulation or DBS, is a Surgical procedure wear a small wire is implanted surgically into the area of the brain where tremors originate (the thalamus). A low electrical current is sent to the end of the wire and stimulates the brain.

    • Tremors can be effectively reduced, and for some patients, they have been almost eliminated.
    • In this procedure, your doctor will adjust the electrical stimulation and place a battery-powered mechanism in your chest, kind of like a pacemaker.
    • DBS can treat tremors on both sides of the body, and the stimulation level can be adjusted if necessary.

Thalamotomy is a traditional and invasive surgery that targets the area of the thalamus responsible for tremors and surgically destroy it.

    • The process involves inserting probes into the deep brain tissue to find the targeted treatment Point.
    • Like the other non-invasive treatments, the patient is usually awake.
    • Only the scalp areas where they insert probes are numbed.
    • Several methods can be utilized to kill the brain cells in this process, including surgical probes that either heat or cool, or emit a radio frequency.

Focused X-rays, a type of stereotactic radiosurgery, can now be used to target the point in the thalamus where tremors originate.

    • In this non-invasive process, a device commonly called “the gamma knife” is used.
    • The gamma knife takes nearly 200 streams of radiation; each of them is not harmful alone.
    • When aimed at the precision target, the combined energy destroys the cells responsible for the tremors.

Ultrasound can be used as another hand tremor treatment method. A new process called Neuravive is a non-invasive way to treat hand tremors.

    • It is very similar to the gamma knife process, with the exception that there are over 1000 beams of ultrasound that are guided using an MRI and no radiation.
    • The MRI-guided and focused ultrasound (MRgFUS) system is utilized by the “Sperling Medical Group” in the procedure they call “Neuravive.”
    • This procedure is completed in about three hours, and the results are immediate.

As with any surgeries, there are risks that you will need to discuss with your neurologist and decide whether they outweigh the possible benefits.

Hand Tremor Therapy

Your doctor may recommend physical therapy once you have your hand tremor diagnosis. Exercises learned from your physical therapist can help you increase your muscle strength and coordination to help you control your tremor.

Occupational therapy for essential tremor is used to help you learn adaptive skills to minimize the effect tremors have on your daily activities.

Some things your occupational therapist might recommend are:

  • Weighted pens and pencils with wide grips to help you write.
  • Heavy forks spoons and knives to help you eat.
  • Weights for your wrists can sometimes reduce tremor in your hands and arms.
  • Clothing with Velcro or easy to use hooks rather than buttons


Psychological therapy might be a good idea if anxiety, post-traumatic stress disorder (PTSD), or some other concern is causing your tremor. Your doctor might recommend a therapist to teach you relaxation techniques and behavior modifications. A therapist can prescribe certain medications to help reduce or eliminate your tremors.


It is nice to know, once you have a reliable diagnosis for your hand tremors, that there are steps you can take to try to improve your condition.

For many of us with a mild to moderate hand tremor, very little to nothing at all may need to be done to live very comfortably with our hand tremors. Severe and life-altering tremors could require one or more of the therapies or treatments listed above. Be sure to discuss all of your options with your doctor.

Living with essential tremors can have an impact on how you feel in social situations. Talk to a therapist or counselor if you are becoming anxious and uneasy about social gatherings. Consider connecting with a support group that can help you address the challenge hand tremors bring to life.


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Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

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