[6] It is typically symmetrical, and affects the arms, hands, or fingers; but sometimes involves the head, vocal cords, or other body parts.

[4] Treatments for essential tremor include medications, typically given sequentially to determine which provides the most efficacy with least side effects.

[12] In mild cases, ET can manifest as the inability to stop the tongue or hands from shaking, the ability to sing only in vibrato, and difficulty doing small, precise tasks such as threading a needle.

Even simple tasks such as cutting in a straight line or using a ruler can range from difficult to impossible, depending on the severity of the condition.

Tremor and disease activity can intensify in response to fatigue, strong emotions, low blood sugar, extreme cold and heat, caffeine, lithium salts, some antidepressants, stress, and other factors.

More severe tremors, a lower sleep disorder frequency, and a similar prevalence of other non-motor symptoms also can occur.

Olfactory dysfunction (loss of sense of smell) is common in Parkinson's disease, and has also been reported to occur in patients with essential tremor.

[37] About half of the cases are due to a genetic mutation and the pattern of inheritance is most consistent with autosomal dominant transmission, meaning patients with Essential Tremor have around a 50% chance to pass it on to their children.

[32] Other mutations in genes such as the HTRA Serine Peptidase 2 (HTRA2) and the teneurin transmembrane protein 4 (TENM4), have been observed in a Turkish family and the Spanish population respectively.

[32] Recent post mortem studies have displayed alterations in the leucine-rich repeat and immunoglobulin-like domain-containing protein 1 (LINGO1) gene[40][41] and GABA receptors[42] in the cerebellum of people with essential tremor.

There are other poisons that work in a similar manner to lead such as other heavy metals like mercury and aluminum, as well as toxic chemicals like certain pesticides and alcohol.

This activity makes neurons fire in a regular, synchronized way, which then disrupts signals to the cerebellum and leads to tremors.

[51] However, recent studies, especially those examining brain tissue, propose a new hypothesis that ET may be a neurodegenerative disease focused in the cerebellum, differing from the old theory[52].

Although ET was long considered a single-symptom illness, recent studies have shown that some patients also experience other additional motor symptoms and non-motor features.

The first approach in helping people to improve tremor symptoms is the discontinuation of triggering and exacerbating factors like medications including certain antidepressants, anti-epileptics, beta-agonists; or substances like caffeine.

[67] Occupational therapy provides support to help people manage everyday tasks more easily through different approaches and interventions.

This strategy was recommended to help avoid the possible side effects of nausea, vomiting, and excessive sedation of primidone.

[67] Additional medications that have been reported to show efficacy in treating ET are gabapentin, benzodiazepines such as alprazolam, clonazepam, and zonisamide, and pregabalin.

BoNT works by inhibiting acetylcholine release at the presynaptic terminal by inactivating the SNARE proteins (SNAP-25), which interfere with muscle contraction.

[79] BoNT type A injections have shown benefits in several clinical trials for the treatments of limb, voice, and head.

[80] Additionally, MRI-guided high-intensity focused ultrasound is a nonsurgical treatment option for people with essential tremor who are medication refractory.

[81][82] MRI-guided high-intensity focused ultrasound does not achieve healing, but can improve the quality of life by reducing the tremor manifestation.

[81][82][85] This procedure is contraindicated in pregnant women, persons who have non-MRI compatible implanted metallic devices, allergy to MR contrast agents, cerebrovascular disease, abnormal bleeding, hemorrhage and/or blood clotting disorders, advanced kidney disease or on dialysis, heart conditions, severe hypertension, and ethanol or substance abuse, among others.

[82] The US Food and Drug Administration (FDA) approved Insightec's Exablate Neuro system to treat essential tremor in 2016.

[92] Family history plays a significant role in the development of ET, with around 50% of cases being hereditary and a 90% concordance rate in identical twins.

[97][98][99] The tremor was noticeable by the time of her performance in the 1979 film The Corn Is Green, when critics mentioned the "palsy that kept her head trembling".

In 2010, musician Daryl Dragon of The Captain and Tennille was diagnosed with essential tremor; the condition became so severe that he was no longer able to play the keyboards.

[103] In 2022, Matthew Caws of Nada Surf and his son made a PSA called "Living with a Mild Essential Tremor".

[105] Harmane or harmaline has been implicated not only in essential tremors, but is also found in greater quantities in the brain fluid of people with Parkinson's disease and cancer.

It has currently been approved by the FDA and designated as GRAS, and is used as a food additive and has been studied as part of a ketogenic diet for treatment of epilepsy in children.