Patient Info

A tremor is an uncontrollable shaking or rhythmic movement in a part of the body — most commonly the hands. But it can also affect the head, voice, arms, legs, or even the entire body in some cases.

Tremors can be mild or noticeable, occasional or frequent. Sometimes, they only happen when you’re doing something — like holding a cup or writing. Other times, they show up even when you’re at rest.

People usually notice tremors in small ways first — often during everyday tasks:

• Your hand shakes slightly when drinking from a Cup
• You struggle to write neatly or hold a spoon steadily.
• Your voice trembles while speaking.
• Your head or jaw moves slightly without you intending it.

These movements may come and go, or they may slowly become more consistent. At first, it might be easy to blame it on tiredness, age, or “nerves”, but if it persists, it’s worth looking deeper.

That shaky feeling can be scary when you don’t know what’s causing it.

Tremors are often part of a known medical condition and understanding the cause is the first step to taking back control.

What Causes Tremors?

Tremors aren’t a disease by themselves — they’re a symptom, and they can happen due to many different reasons. Some are temporary or lifestyle-related, while others may be linked to a neurological condition.

Some Temporary or Reversible Causes are:

• Stress or anxiety
• Fatigue or physical weakness
• Too much caffeine or nicotine
• Low blood sugar
• Side effects of certain medications
• Thyroid problems

Neurological or Medical Causes

• Essential Tremor (ET) – a movement disorder often mistaken for stress-related shaking
• Parkinson’s Disease (PD) – a progressive brain condition with a distinct tremor pattern
• Stroke or brain injury
• Multiple sclerosis (MS)
• Liver or kidney issues (in advanced stages)

When Should You See a Doctor?

If the tremor is interfering with daily activities, seems to be getting worse or if you’re just unsure why it’s happening…it’s best to consult a neurologist. A proper evaluation can help identify the cause, and more importantly, guide the right treatment or support.

Living with Essential Tremors? You’re Not Alone.

What is Essential Tremor?

Essential Tremor (ET) is a neurological condition that causes involuntary shaking, often in the hands, head, voice, or legs. It can look very different from person to person. For some, it’s a slight shake that comes and goes but for many, simple daily activities like drinking a glass of water, writing, or buttoning a shirt can become a struggle. Believed to affect nearly 80 million people worldwide, ET is far more common than most people think.

The primary symptoms associated with essential tremor include:

• Uncontrollable shaking that occurs for brief periods of time
• Begins gradually, usually on one side of the body
• Occurs in the hands first, affecting one hand or both
• Can include a shaking voice or tremor of the head
• Nodding head
• Worsening during periods of emotional stress and purposeful movements but not caused by it.

ET is not caused by anxiety or weakness.

It’s a medical condition and there are many advanced treatment options available.

What are the treatment options available?

Treatment options for Essential Tremor vary from person to person. The right treatment approach depends on several factors, including the severity of your symptoms, how they impact your daily life, and how you respond to treatment. A detailed consultation with your neurologist will help determine the approach that’s right for you and support you in regaining control and improving your quality of life.

The journey in treating ET begins with First line Medications supported by lifestyle C behavioural modifications. When medications and therapies are not enough, advanced interventional options such as the surgical procedure, Deep Brain Stimulation and the Incisionless MR-guided Focused Ultrasound have succeeded in targeting the source of tremors with extraordinary precision and resulting in a remarkable reduction of tremors. A range of supportive therapies, including but not limited to physical therapy, occupational therapy, and rehabilitation exercises, have shown benefits in improving muscle strength, control, and coordination. In addition, advances in adaptive tools and neurostimulation devices are driving innovation in the way tremors can be managed — offering patients new options that are designed to help manage specific physical aspects of tremor and improve daily function.

Your doctor may prescribe one or more of the following medications:

• Beta Blockers (like Propranolol): Although originally used for high blood pressure, beta blockers can also help reduce tremors. They’re one of the most common starting points. But they may not be ideal for everyone, especially if you have asthma or certain heart conditions. Some people also experience tiredness or feel a bit dizzy while on them.
• Anti-Seizure Medications (like Primidone, Gabapentin, or Topiramate): These work by calming overactive nerve signals in the brain. They are often used if beta blockers aren’t effective, or may be added for extra support. When you first start these, you might feel drowsy or slightly nauseous — but those side effects often ease up with time.
• Tranquilizers (such as Clonazepam): If your tremors seem to get worse with anxiety or stress, your doctor might suggest a benzodiazepine like Clonazepam. These can help relax the body and reduce shaking, though they’re usually used short-term or with caution since they can be habit-forming and may cause drowsiness.
• Nerve Blockers: In certain cases of tremors that affect the head or voice, OnabotulinumtoxinA — more commonly known as Botox injections — may offer relief. They work by temporarily relaxing the muscles responsible for the tremor, with results that can last up to three months. However, there are trade-offs. When used to treat hand tremors, it could cause weakness in the fingers. For voice tremors, it can lead to hoarseness or mild difficulty swallowing.

Advanced Treatment Options are:

Deep Brain Stimulation (DBS) is a neurosurgical procedure for moderate to severe Essential Tremor (ET), especially when medications no longer work. In this procedure, electrodes are implanted into a part of the brain called the thalamus. These electrodes are connected to a pacemaker-like device placed under the skin in the chest, which delivers finely tuned electrical impulses to calm the tremor. DBS is fully adjustable and reversible, allowing neurologists to personalize the stimulation settings over time for optimal control. It’s especially beneficial for patients with tremors on both sides of the body, offering long-term relief and improved function.

MR-Guided Focused Ultrasound (MRgFUS) uses high-intensity ultrasound waves,

guided in real time by MRI imaging, to precisely target and ablate a tiny area of a part of the brain called the thalamus which is causing the tremors. The result is often dramatic and immediate tremor reduction – all without incisions, implants, or anesthesia.

MRgFUS is typically offered to patients with tremors on one side. The sheer

convenience, safety profile, and quick recovery make MRgFUS a choice treatment for patients looking to regain control with minimal disruption when all other methods have failed them.

What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a progressive neurological condition that primarily affects movement. It develops when certain nerve cells in the brain that produce dopamine begin to break down or die. Dopamine is essential for controlling movement and coordination, and as its levels drop, symptoms of Parkinson’s begin to appear.

PD doesn’t look the same for everyone. For some, it starts subtly — a mild tremor or stiffness in one hand. For others, it can gradually affect how they walk, speak, or even express emotions. While the progression can vary, many people continue to live meaningful, independent lives with the right support and treatment.

The primary symptoms associated with Parkinson’s Disease include:

• Tremors, often beginning in the hands or fingers at rest
• Slowness of movement making everyday tasks take longer (bradykinesia)
• Muscle stiffness, which can limit range of motion
• Balance and coordination issues, sometimes leading to falls
• Changes in handwriting, facial expression, or speech tone

PD is not just “old age” or “slowing down.”

It’s a medical condition that can be treated and there are many ways to manage symptoms and maintain a fulfilling quality of life.

What are the treatment options available?

Managing Parkinson’s is a personal journey and no two paths are the same. The best treatment plan depends on the type and severity of your symptoms, how they affect your daily routine, and what stage of the condition you’re in. A consultation with your neurologist is often the first step.

Most journeys start with medications that aim to replace or mimic dopamine in the brain. These are often very effective in improving symptoms in the early stages. Over time, as symptoms evolve, your treatment plan may be adjusted — sometimes adding medications or exploring more advanced options.

Here are some of the common medications your doctor might suggest:

• Levodopa (often combined with carbidopa) – This is the most widely used treatment. It’s converted into dopamine in the brain and helps control movement.
• Dopamine agonists – These medicines (like pramipexole or ropinirole) don’t become dopamine but act like it, helping stimulate brain cells directly.
• Monoamine oxidase B (MAO-B) inhibitors – MAO B inhibitors help block the MAO- B enzyme that breaks down our brain’s dopamine. This slowing down of the breakdown process enables dopamine to stay active in your system longer.

Every medicine has a role — some improve motor symptoms, others help reduce “off times” (when symptoms return between doses), and some support smoother long-term control. For many people, medications can manage Parkinson’s symptoms effectively for years. But over time, the way your body responds to these medicines may start to change. You may notice that the benefits of medications begin to wear off sooner, or don’t feel as strong as they used to — a phenomenon called “wearing off.” This can mean you need more frequent doses or higher amounts to get the same effect. But increasing the dosage always comes with its own challenges. Levodopa, for example, may cause involuntary movements (called dyskinesia) at higher doses. Some people may also feel lightheaded when standing up, caused by a drop in blood pressure known as orthostatic hypotension. Other medications, like dopamine agonists, may bring side effects like nausea, drowsiness, or even hallucinations. In a few cases, they can also lead to compulsive behaviours. When these symptoms become harder to control or side effects interfere with your quality of life, your neurologist may talk to you about advanced therapies that offer more consistent and longer-lasting symptom relief.

Advanced Therapy Options are:

Deep Brain Stimulation (DBS) is a surgical procedure that delivers targeted electrical impulses to specific areas of the brain, helping reduce symptoms like tremors, stiffness, or slow movement.

MR-Guided Focused Ultrasound (MRgFUS) is an incisionless procedure that uses high- intensity ultrasound waves guided by MRI to precisely target and treat areas of the brain responsible for tremors. It is recommended for Patients with Tremor-Dominant Parkinson’s Disease, where tremors are the most disabling symptom and medications have limited effect.

Infusion therapies or pump-based treatments, which deliver medication continuously and can help smooth out symptom fluctuations.

Equally important are supportive therapies that help you stay active and independent:

• Physiotherapy to maintain strength and balance
• Speech and occupational therapy to support communication and daily tasks
• Mental health support to help cope with emotional or cognitive changes
• Diet and lifestyle changes that can positively impact how you feel day-to-day

Advances are continually being made — including promising research into how we understand, detect, and slow the disease. But even today, with the right care, many people with Parkinson’s are living active, connected lives.