Q: My hand shakes when I write. Is this an early sign of Parkinson’s disease?
A: No. You probably have essential tremor, the most common type of shaking, which affects up to 10 million Americans. Katharine Hepburn and Sandra Day O’Connor are famous examples. It is called “essential” because no known underlying factor causes it; it isn’t associated with any illnesses; and there is no medical test to diagnose it. But you should see your doctor to make sure the tremor isn’t caused by another condition, such as an overactive thyroid.
Many people worry that their shaking is caused by Parkinson’s disease, of which tremor is one sign. But with Parkinson’s, the tremor occurs at rest—and there are other signs, too, such as slowed and rigid movement, stooped posture, gait changes, and dulled facial expression. Essential tremor is generally seen not when you are at rest, but when you move your hands or other affected body parts. In actuality, there are about 20 different types of tremor, roughly categorized as resting or action tremors.
Essential tremor usually develops in middle age or later, though it can begin as early as adolescence. It often becomes more noticeable with age or affects more parts of the body (and sometimes the voice). The shaking typically starts in the hands, occasionally just one hand. Most people discover it when they move their hands or try to hold them in particular positions—it can be frustrating to write, put in contact lenses, or drink from a glass.
If one of your parents has or had essential tremor, there’s about a 50 percent chance you’ll get it—thus it’s also called familial tremor.
Try avoiding stimulants like caffeine. Alcohol may temporarily help, but more than one drink may make matters worse—as may fatigue, anxiety, and stress. Improving your muscle strength and coordination under the guidance of a physical therapist is worth exploring. You can also try adaptive devices, such as a weighted glove for writing and non-slip eating utensils. Some devices, including the new ViLim Ball, use vibrations to supposedly reduce hand tremors, but there’s no good evidence (at least yet) to support their effectiveness.
If these self-help measures aren’t enough, and if your tremor really bothers you, talk to your doctor about prescription medications (including certain beta blockers and anti-seizure drugs). For rare cases of severely disabling tremors, surgical options are available.
For more advice, go to the website of the International Essential Tremor Foundation.
Last updated July 2019.
Also see Exercise May Reduce Parkinson's Risk.