Usually yes, but slowly. Essential tremor tends to increase in amplitude over years and may spread from the hands to the head or the voice. It is not life-shortening, and the change is gradual enough that many people manage for a long period before treatment becomes necessary.
Usually yes, but slowly. Essential tremor tends to increase in amplitude over years and may spread from the hands to the head or the voice. It is not life-shortening, and the change is gradual enough that many people manage for a long period before treatment becomes necessary.
Essential tremor is an action tremor: it appears when the hands are held out or used, and settles when they are fully at rest. It is usually present on both sides, though rarely quite symmetrically, and the hands are affected first in most people. Over years the amplitude increases, and involvement of the head, jaw or voice becomes more likely with age and duration. The progression is slow enough that people often date onset years later than a family member would. Many find alcohol briefly reduces it, which is a diagnostic observation rather than a management strategy.
This distinction is the reason most people seek assessment, and several features separate them. Essential tremor appears with action and posture; the classic Parkinson's tremor appears at rest and reduces with movement. Essential tremor is usually bilateral from the outset; Parkinson's tremor typically begins on one side and stays asymmetrical. Parkinson's disease brings slowness, reduced arm swing, rigidity and small handwriting; essential tremor makes handwriting large and tremulous instead. Head and voice tremor favour essential tremor.
Treatment reduces amplitude rather than abolishing tremor, and that is the expectation to set. Propranolol and primidone are the two established first-line agents, chosen against the person's other conditions, and each helps a proportion of people to a useful degree. Where tremor remains disabling despite adequate medical treatment, focused ultrasound thalamotomy and deep brain stimulation are considered. Neither is performed at this practice; referral to a centre that provides them is arranged, and medical management continues alongside.
Function is the trigger, not severity in the abstract. Handwriting that has become unusable, difficulty drinking from a full cup, trouble with tools, buttons or make-up, or avoiding eating in company are all reasonable reasons to review treatment. A sudden change in tremor, or the appearance of slowness, stiffness, balance difficulty or unilateral features, is a different matter and warrants reassessment of the diagnosis rather than an adjustment of dose.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: tremor; National Institute of Neurological Disorders and Stroke; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.