Hand shaking affects millions of Indians — but most people with tremor do NOT have Parkinson's. Dr. Anand Karnam explains the key differences between essential tremor and Parkinson's disease — and why getting the diagnosis right matters.
Key Points
- Essential tremor (ET) is an ACTION tremor — it occurs during movement; Parkinson's tremor is at REST.
- Essential tremor typically affects both hands symmetrically and improves with alcohol; Parkinson's typically begins one-sided.
- Essential tremor does not cause slowness, rigidity, or postural problems — these are Parkinson's features.
- 10 million people globally have essential tremor — it is 8x more common than Parkinson's disease.
- DaTscan (dopamine transporter scan) can definitively distinguish ET from Parkinson's when clinical diagnosis is uncertain.
10M
people globally have essential tremor — 8x more common than Parkinson's
Source: International ET Foundation
4%
of adults over 65 have essential tremor
Source: Movement Disorders Journal
95%
accuracy of DaTscan in distinguishing Parkinson's from ET
Source: European Journal of Neurology
"Essential tremor and Parkinson's tremor look similar to a patient but feel completely different in the examination room. Hold out your hands in front of you — if the tremor appears, that is action tremor, more likely ET. Now rest your hands in your lap completely relaxed — if the tremor appears, that is rest tremor, and Parkinson's moves to the top of my list. This simple distinction changes the diagnosis and treatment completely."
Hand tremor — involuntary shaking of the hands — is one of the most common symptoms bringing patients to Dr. Anand Karnam's neurology clinic in Hyderabad. The first question every patient asks: "Do I have Parkinson's?" In the majority of cases, the answer is no — the tremor is essential tremor, a condition that, while sometimes progressive, is not Parkinson's disease and does not carry the same implications.
The Key Difference: When Does the Tremor Occur?
This single question distinguishes most cases:
Essential Tremor: The tremor occurs during ACTION — when the hands are being used (holding a cup, writing, eating, using a phone). The tremor is absent or minimal when the hands are resting in the lap. This is called "action tremor" or "postural tremor."
Parkinson's Disease: The classic tremor is a "resting tremor" — the hands shake when the person is sitting quietly with hands in the lap, and the tremor typically REDUCES or DISAPPEARS when the person intentionally moves their hand. The classic Parkinson's tremor is often described as "pill-rolling" — a rhythmic rolling motion of the thumb over the fingers at rest.
Other Features That Help Distinguish
| Feature | Essential Tremor | Parkinson's Disease |
|---|---|---|
| When tremor occurs | During action/movement | At rest, reduces with movement |
| Body parts affected | Both hands, head, voice | One hand first, leg, jaw |
| Other motor features | None | Slowness, rigidity, small steps |
| Family history | Common (autosomal dominant) | Less common (10–15% familial) |
| Alcohol effect | Tremor improves transiently | No consistent change |
| Writing | Large, tremulous script | Small, cramped script (micrographia) |
Essential Tremor — Is It Progressive?
Essential tremor can worsen over decades, but does not lead to Parkinson's disease (they are separate conditions, though some overlap exists). In many patients, it remains mild and manageable. Treatment options: propranolol (beta-blocker) and primidone are first-line medications with good evidence. For severe essential tremor not responding to medication, deep brain stimulation (DBS) is remarkably effective.
Other Causes of Tremor
Before diagnosing either condition: thyroid function tests (hyperthyroidism causes tremor), check medications (salbutamol inhalers, valproate, lithium, caffeine excess all cause tremor), check for Wilson's disease in young patients (copper metabolism disorder — treatable). A careful medication history and basic blood tests are essential before any tremor diagnosis.
For tremor evaluation and neurology consultation: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.
Dr. Anand Karnam
DrNB Neurology · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
DrNB-qualified Neurologist, Fellow of the World Headache Society (FWHS), and Headache Specialist with 12+ years of experience treating epilepsy, stroke, migraine, and movement disorders. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Essential Tremor — NCBI StatPearls — NCBI StatPearls
- 2.Parkinson Disease — WHO — World Health Organization
- 3.Tremor — NIH MedlinePlus — NIH MedlinePlus
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