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Is It Parkinson’s or Essential Tremor?

Because one of the specialties your primary care doctors at Cohen Medical Associates in Delray Beach, Florida, offers is senior care, we often encounter patients who worry that they are developing Parkinson’s disease (PD).

This is not unusual, because Parkinson’s affects nearly a million people in the United States, according to the Parkinson’s Disease Foundation, with nearly 60,000 new cases diagnosed each year, mainly among older Americans.

A diagnosis of Parkinson’s disease can be frightening, because it is progressive, meaning it becomes worse over time. Symptoms include the familiar body tremors, as well as difficulties with balance and coordination, loss of the ability to smell, insomnia, dizziness, fainting, stiff limbs, and difficulty walking and even speaking.

But just because an older person has tremors, that doesn’t lead to an automatic diagnosis of PD. In fact, many things can cause a person’s hand to shake, from too much caffeine to certain medications, along with more serious (but rare) diseases. The most common cause of hand tremors is a condition called essential tremor (ET).

While ET can occur at any age, PD incidence tends to increase with age. The most famous examples of celebrities with each condition are Katharine Hepburn, who had ET her whole life, and Michael J. Fox, who was diagnosed with PD in his 30s. Although Fox’s illness occurred early in his life, only 4 percent of people with PD are diagnosed before age 50.

ET and PD are two distinct conditions that have only the tremors in common. Diagnosing the causes for tremors can be difficult, but one telltale difference is when they occur: tremors associated with PD tend to occur when the person isn’t moving; essential tremors tend to happen only when someone is moving muscles, as in trying to write or to pick up a utensil.

ET used to be called “benign essential tremor,” but in recent years the word “benign” was dropped, because although ET doesn’t impact life expectancy, it can be debilitating when sufferers must deal with it. (Parkinson’s usually doesn’t result in death, either—you typically die with PD, not from it.)

It’s important to know the cause of your tremors, because although neither condition is curable, both can be treated to help lessen symptoms, but both are treated completely differently.

Medications for debilitating ET may include beta blockers, tranquilizers, anti-seizure medications, and possibly Botox injections, which can sometimes alleviate symptoms of ET for as long as three months at a time. Physical and occupational therapy have also been found useful, as has deep brain stimulation (DBS) for severe cases. (DBS is also used in the treatment of PD.)

When you come to us for an evaluation, we will perform a neurological examination to check tendon reflexes and muscle strength and tone, among other related tests; laboratory tests to check for such causes as thyroid disease and metabolic problems; and a performance evaluation, to observe how you write, draw circles, or drink from a glass.

If we cannot reach a definitive diagnosis, we may refer you to a neurologist or movement disorders specialist who will attempt to rule out one or more other causes. No specific test exists to diagnose PD, but if the neurologist suspects PD, they may order a trial dose of carbidopa-levodopa, a medication that has been successful in helping to control PD symptoms. If your symptoms subside on this drug, that would tend to confirm a diagnosis of PD.

Whether your tremors are connected to PD, ET, or something else, please see us for an evaluation. Worry doesn’t help any health condition, nor does it make sense to suffer from symptoms that can be treated. So pick up the phone—we’re here to help.