How much tremor is too much?

February 26, 2013 Ryder P. Gwinn, MD

Tremor is a normal physiologic reaction to anxiety or stress, but it is not normal to have a tremor when performing typical daily activities.

People who develop a tremor while eating, drinking, writing or doing other common activities may have a movement disorder called Essential Tremor. This is actually the most common movement disorder, and can affect up to 4% of people over age 40. People who have this disorder can take medications to help minimize the tremor, but they don't often reduce the tremor by more than about half. Deep brain stimulation (DBS) is an excellent treatment option for people with severe tremor, and can nearly eliminate the tremor in many patients. Many patients aren't sure when their tremor is severe enough to warrant surgery, and much of our conversation in the office is to help answer this question.

There is no one answer that is right for everyone, but for me it has to do with how well someone is actually doing in their daily life:

  • Is there a lot of anxiety produced by the tremor itself?
  • Are there activities that the patient has completely avoided or hobbies that they have stopped because of the tremor?
  • Are you not going out to eat in restaurants because you are afraid of embarrassment or spilling something?

All of these things point to a tremor that is starting to really affect quality of life, and surgery may be enable someone to once again enjoy simple things that have been lost.

If you think your tremor is severe, then you should be evaluated by a movement disorder neurologist, and they can help to make sure the diagnosis is right. They can also make sure the right medications have been prescribed, and then make a referral to surgery when appropriate. Surgery is a big decision, and its important to get support and education to make the right choice.

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