Shaking Hands: Is It Parkinson's or Essential Tremor?

When someone's hands start shaking, the first fear is often Parkinson's disease. But the far more common cause of tremor is essential tremor — a very different condition. Getting the right diagnosis matters because the treatment is completely different.

Essential Tremor vs Parkinson's: The Key Difference

The single most important difference to know:

• Essential tremor: The shaking is WORSE when the hands are being used (action tremor) — when holding a cup of tea, signing a cheque, or eating with a spoon.
• Parkinson's tremor: The shaking is WORSE when the hands are at REST — sitting quietly in the lap. It tends to improve (briefly) when the hands are used.

Essential Tremor

Essential tremor is the most common movement disorder — roughly 10 times more common than Parkinson's. It affects about 5% of people above 60. It can run in families (familial tremor). It affects the hands most often, but can also affect the head (nodding tremor) and voice.

A useful clue: many patients with essential tremor notice that a small amount of alcohol temporarily reduces the tremor — this does not happen in Parkinson's.

Treatment options include beta-blockers (propranolol), primidone, and for severe cases that don't respond to medication, deep brain stimulation or focused ultrasound.

Parkinson's Tremor

Parkinson's tremor typically starts in one hand and gradually involves the other side. It is accompanied by other features — slowness of movement, muscle stiffness, reduced facial expression, and smaller handwriting. These features are absent in essential tremor.

Other Causes of Tremor

• Physiological tremor — enhanced by stress, caffeine, thyroid overactivity, certain medications
• Drug-induced tremor (e.g. certain psychiatric medications)
• Cerebellar tremor — rhythmic, affects coordination
• Psychogenic tremor

Why the Right Diagnosis Matters

Giving Parkinson's medication to someone with essential tremor — or vice versa — will not help and may cause side effects. An accurate diagnosis from a neurologist, often with the help of brain MRI and sometimes DaTSCAN, is essential before any treatment is started.

"Don't assume every hand tremor is Parkinson's — or dismiss it as 'old age'. A neurologist can determine the exact type of tremor in a single consultation and outline the appropriate management."

Dr. Anand Karnam is a movement disorders specialist at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad. Call +91 90633 66983.