 We've all seen the shaking hands of a very elderly person who no longer can hold a cup full of tea or address a letter legibly. Many of us have come to see this common condition as the natural consequence of extreme old age. However, this is not the case.
Trembling hands are not due to the simple process of aging. They are characteristic of a movement disorder now correctly understood as "essential tremor," a neurologic disorder in which the victim exhibits a rhythmic trembling of the hands, head, trunk, voice and, less commonly, the legs and feet.
Almost five million seniors aged 60 years or older have the disorder, but ET is not confined to the elder years. Children have displayed the tremors of ET as early as birth, although symptoms are rarely seen before 10 years of age. One in 20 persons older than 40 and one in five persons older than 65 have some form of ET, says Shirley Rittgers, a speaker for the International Essential Tremor Foundation. Rittgers has extensive knowledge of the condition because she has had ET for years. "It's really just a minor irritation," she quips.
One of the pieces of literature from IETF that Rittgers brings to show her audiences is a study by Elan Louis, MD, that examines one of the few documented historical cases of ET. The subject is Samuel Adams (17221803), who was one of the signers of the Declaration of Independence and one of the architects of the American Revolution. The study traces the slow progress of ET in Adams throughout the years of his writings and exhibited in the development of oscillations in his penmanship toward the latter years. By age 71, Adams was unable to write and used the help of others to draft his correspondence.
Many of us remember Katherine Hepburn, the actress who had noticeable head and voice tremor. She was able to continue her career long into her elder years in spite of her ET. An interesting study was done in the mid-1990s that concluded that women are more likely to develop head and voice tremor (60 percent) and men were less likely to develop this combination (30 percent). The study's report also noted that nearly all of the subjects in the study had hand tremor, although this form of ET was more severe in men. The head and voice tremor was more severe in women. No variable other than gender showed such significant differences.
Most of us are unaware that our own hands tremble. Rittgers recommends that people try to hold a piece of paper for a short time and watch the movement that results. The reason is that the motions of our body processes—the beating of heart and the movement of chest as we breathe—has a ripple effect on our muscles. Stress and stimulants like caffeine can accentuate those normal tremors and flutters. For people with ET, the shaking occurs more often and may be more noticeable and more rhythmic than it would be for someone without ET.
ET is generally inherited. It has no known association with Parkinson's Disease, but can be misdiagnosed as PD. ET is considered an action tremor that is seen in postural (voluntarily maintaining a position against gravity) and kinetic (performing any kind of deliberate movement) actions. ET patients do not tremble when completely relaxed, as in sleep.
The tremor may be a rhythmic "back-and-forth" or "to-and-fro" movement produced by involuntary (unintentional) contractions of muscles. The severity can vary from hour to hour and day to day, depending on stress or activities. ET does not usually affect muscle tone, strength or balance, but no one can predict how much the tremor will worsen with time. The course of ET is variable and may be progressive over many decades.
Treatment is available, but other possible causes for tremors need to be eliminated first, including thyroid disease, tumors, heavy metal poisoning, drug side effects (caffeine, alcohol, some prescribed medications) and PD. Brain scans and blood tests can help in arriving at the correct diagnosis.
Most people have mild or moderate tremor, but quality of life becomes an issue for severe cases of essential tremor. Several medications (propranolol, primidone) are routinely used that can reduce the severity of tremor temporarily for important activities and events. Recently, surgical techniques involving implants have been able to block electric impulses that cause tremor. A 50-percent reduction in tremor is considered good. The bulk of ET patients are helped by these interventions.
IETF offers literature that outlines the many ways that people with ET can cope with their daily challenges: writing, eating, playing golf, handling tools, using a computer, and other activities that most people take for granted.
IETF promotes support groups and meetings to help members learn from experts and each other how to live a fulfilling and exciting life in spite of ET. Shirley Rittgers at the Villages in San Jose is one of the support-group contacts for this area. Call her for more information at 408.274.1393 or email her at ritts@sbcglobal.net. IETF can be reached at its toll-free number, 888-387-3667.
Andrea Dorey is a licensed vocational nurse, medical writer and former AARP president. Contact her at andid@cagreens.org.
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