Known risk factors for essential tremor include:

• Altered gene. The inherited variety of essential tremor, known as familial tremor, is an autosomal dominant disorder. That means an altered gene from just one parent is needed to pass on the condition.

  Anyone who has a parent with an altered gene for essential tremor has a 50% chance of developing the condition.

• Age. Essential tremor is more common in people age 40 and older.

Diagnosing essential tremor involves a review of your medical history, family history and symptoms, and a physical examination.

There are no medical tests to diagnose essential tremor. Diagnosing it is often a matter of ruling out other conditions that could be causing symptoms. To do this, your healthcare professional may suggest the following tests.

Neurological exam

In a neurological exam, your healthcare professional tests how well your nervous system is working. This may include checking your:

• Tendon reflexes.
• Muscle strength and tone.
• Ability to feel certain sensations.
• Posture and coordination.
• Walk and balance.

Lab tests

Blood and urine may be tested for several factors, including:

• Thyroid disease.
• Metabolic problems.
• Medicine side effects.
• Levels of chemicals that may cause tremor.

Performance tests

To evaluate the tremor itself, your healthcare professional may ask you to:

• Drink from a glass.
• Hold your arms outstretched.
• Write.
• Draw a spiral.

A healthcare professional who still is not sure if a tremor is essential tremor or Parkinson's disease might order a dopamine transporter scan. This is a special imaging test that uses an injected medicine to show where the chemical dopamine is found in the brain. It can help the healthcare professional tell the difference between the two types of tremors.

Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your healthcare professional.

Treatment options may include:

Medicines

• Beta blockers. Typically used to treat high blood pressure, beta blockers such as propranolol (Inderal LA, InnoPran XL, Hemangeol) help relieve tremors in some people. Beta blockers may not be an option for people with asthma or certain heart problems. Side effects may include fatigue, lightheadedness or heart problems.
• Anti-seizure medicines. Primidone (Mysoline) may be effective in people who don't respond to beta blockers. Other medicines that might be prescribed include gabapentin (Gralise, Neurontin, Horizant) and topiramate (Topamax, Qudexy XR, others). Side effects include drowsiness and nausea, which usually disappear within a short time.
• Tranquilizers. Healthcare professionals may use benzodiazepines such as clonazepam (Klonopin) to treat people whose tremors worsen with tension or anxiety. Side effects can include fatigue or mild sedation. These medicines should be used with caution because they can be habit-forming.

• Nerve-blocking injections. Injections with onabotulinumtoxinA, also known as Botox, might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.

  However, if Botox is used to treat hand tremors, it can cause weakness in the fingers. If Botox is used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.

Therapy

Healthcare professionals might suggest physical or occupational therapy. Physical therapists can teach you exercises to improve your muscle strength, control and coordination.

Occupational therapists can help you adapt to living with essential tremor. Therapists might suggest adaptive devices to reduce the effect of tremors on your daily activities. These devices may include:

• Heavier glasses and utensils.
• Wrist weights.
• Wider, heavier writing tools, such as wide-grip pens.

Nerve stimulation devices

A wearable electronic peripheral nerve stimulation device (Cala Trio, Cala kIQ) is a newer treatment option for people with essential tremor. The device is worn as a wristband for 40 minutes twice a day. It works by stimulating nerves and muscles to create a muscle response that reduces tremors. Studies have found that the device can bring some improvement for tremors.

Surgery

Surgery might be an option if your tremors are severely disabling and you don't respond to medicines.

• Deep brain stimulation. This is the most common type of surgery for essential tremor. It involves putting a long, thin electrical probe into the part of the brain that causes the tremors, known as the thalamus. A wire from the probe runs under the skin to a device called a neurostimulator that's placed under the skin in the chest. This device sends painless electrical pulses to interrupt signals from the thalamus that may be causing the tremors.

  Side effects of deep brain stimulation can include equipment malfunction and problems with motor control, speech or balance. Headaches and weakness also may be side effects. After some time or adjustment of the device, side effects often go away.

• Focused ultrasound thalamotomy. This noninvasive surgery involves using focused sound waves that travel through the skin and skull. The waves generate heat to destroy brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses MRI to target the correct area of the brain and to be sure the sound waves are generating the exact amount of heat needed for the procedure.

  Focused ultrasound thalamotomy is done on one side of the brain. The surgery affects the other side of the body from the one where it's done.

  Focused ultrasound thalamotomy creates a lesion that can result in permanent changes to brain function. Some people have experienced altered sensation, trouble with walking or difficulty with movement. However, most complications go away on their own or are mild enough that they don't interfere with quality of life.