Essential tremor

A shaking that happens during movement, not at rest. Eight times commoner than Parkinson's, and constantly confused with it.

What it is

Essential tremor is the commonest movement disorder there is, affecting around 1 million people in the UK. It is roughly eight times commoner than Parkinson's disease, and it is regularly mistaken for it, which causes enormous unnecessary fear.

The distinction is straightforward once known. Essential tremor happens when the hands are doing something: holding a cup, writing, using a spoon. Parkinson's tremor happens at rest and reduces on movement.

It often runs in families and it usually worsens slowly over decades. It is not dangerous, and calling it benign, as the old name did, badly understates what it does to a life.

Signs you might notice

Shaking of the hands during activity: holding a cup, pouring, using cutlery, writing.

Head tremor, a nodding or shaking, and sometimes a shaky voice.

Worse with stress, caffeine, tiredness and being watched.

Often temporarily better after a small amount of alcohol, which is a recognised diagnostic clue and is also a route into problem drinking.

No slowness, stiffness or shuffling walk, which is what separates it from Parkinson's.

How it can affect day-to-day life

The social cost is what people report, not the physical one. Eating in restaurants, signing documents in front of others, holding a drink at a wedding, giving a presentation. People withdraw from all of it.

Work is affected in any role requiring fine control, and adjustments are rarely offered because the condition is not taken seriously.

The alcohol response deserves care. It is real, it is temporary, and using it as self-treatment leads a meaningful number of people into dependence.

Supporting someone well

Say plainly that it is not Parkinson's, if that has been confirmed. The relief is substantial and people often carry the fear silently.

Use weighted cutlery, weighted cups, and cups with lids. Small equipment changes restore a great deal of dignity.

Reduce caffeine and manage stress, both of which genuinely amplify it.

Ask about treatment. Propranolol and primidone both help many people, and focused ultrasound or deep brain stimulation are options in severe cases.

Do not comment on the shaking, and do not take the cup away without being asked.

Ask for an occupational therapy assessment. There is far more equipment available than most people know about.

Where to get help

A GP can start treatment and refer to a neurologist if the diagnosis is uncertain.

The National Tremor Foundation provide support and information.

Sudden onset tremor, or tremor with other neurological symptoms, needs assessment rather than reassurance.