Ask The Doctor

Tremor Is Not Always Parkinson’s Disease

Dear Dr. Garner,

I am very worried that I have Parkinson’s disease. My hands are shaking all the time, and it’s getting me more and more nervous. My aunt had Parkinson’s disease and ended up in a nursing home.

I went to the doctor, and he told me I have something called essential tremor. Is there a way to tell the difference between essential tremor and Parkinson’s disease for sure?

Parkinson Phobic

Prospect Park West


Dear Parkinson Phobic,

Shaking of the hands is a well known part of Parkinson’s disease. There are, however, many other causes for shaking of the hands. Some include reactions to medication, low blood sugar, excessive alcohol consumption, an overactive thyroid, stress, anxiety, fatigue and too much coffee or tea. It is the type of tremor, and the associated medical conditions, that classifies the underlying disease.

Your doctor has made a diagnosis of essential tremor. This is based upon your history and physical exam. There are marked differences between Parkinson’s disease and the condition with which you have been diagnosed.

Pronounced During Simple Tasks

In essential tremor, the shaking of the hands is most pronounced when one attempts to do simple tasks, such as drinking a glass of water, tying shoelaces, shaving or writing. Essential tremor can cause alterations of the voice and shaking of the head. In essential tremor, shaking usually occurs in the hands with either one or both hands affected. The head can develop tremors in either the “yes, yes” or “no, no” position.

In Parkinson’s disease, the key symptom is shaking of the hands, which is worse when the patient is at rest and tends to disappear when the patient does a task such as drinking or holding other objects.

Parkinson’s disease often starts with a back and forth rubbing of the thumb and forefinger. A person’s posture becomes stooped, and balance is difficult. There is a slowing or freezing of movement in Parkinson’s disease, and the face shows little or no expression. Speech becomes soft and mumbling.

About half of essential tremor cases are due to genetic mutation, which is inherited. It is often seen in family members. If you have one parent who has a gene mutation for essential tremor, then you have a 50 percent chance of developing the disorder. Parkinson’s disease has a much lower prevalence of inheritance.

The exact cause of Parkinson’s disease is unknown, but there is some genetic mutation associated with it. In addition, environmental triggers, such as exposure to toxins (pesticides and other herbicides) or certain viruses, may trigger Parkinson’s signs and symptoms. Both illnesses are treated with medications. Both diseases affect people in their middle to older age.

For those patients who do not respond to medication, there is a treatment known as deep brain stimulation. The process involves inserting a long, thin electrical device into the portion of the brain responsible for the shakes. A wire device is connected to what looks like a pacemaker under the skin in the chest. It sends out painless electrical impulses to interrupt the abnormal signals from the brain that may be causing the tremor. While there are side effects with this treatment, it has proven to be a great benefit to many.

The take-home message regarding your condition is that essential tremor typically has a less aggressive course than Parkinson’s disease. The tremor can usually be controlled with medication and is not associated with the generalized medical problems.

I hope that this discussion helps shed light regarding essential tremor and its comparison with Parkinson’s disease.

The key part is to see your doctor so that symptoms can be kept to a minimum and the progression slowed.

Until next week, be well.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.