Parkinson's disease

Many an aging person has trembling hands--a sure sign, in their minds, of the onslaught of dreaded Parkinson's disease or embarrassing unsteadiness of old age.

Both suspicions may well be unwarranted. Instead, the tremors could be symptoms of what's known as essential tremor (ET), a neurological condition suffered by about five million Americans, mainly over age 60. It is not deadly or contagious, but it sometimes worsens with the years. It typically is an inherited disorder.

Essential tremor, physicians say, is thought to be caused by a "dominant gene." That means all of the children of a person with ET have a 50 percent chance of inheriting the gene--not half the children, but each with his or her own 50 percent chance. But even the child of a patient with severe ET who inherits the gene may have a very mild disorder.

Many people associate tremors with Parkinson's disease, a well-known degenerative disorder. Essential tremor and Parkinson's, however, are not linked in any way. No studies have shown that essential tremor increases your risk of getting Parkinson's, according to the Essential Tremor Foundation.

Also, the two differ in these ways: Essential tremor of the hands occurs usually when the hands are in use. Tremor from Parkinson's is most common when the hands are at rest--say, in your lap.

Essential tremor causes no other health problems. Parkinson's, on the other hand, is associated with stooped posture, rigid limbs, slow movement, speech problems, and sometimes memory loss.

Your doctor's decision about treatment depends on how long you've had it and how much it affects your lifestyle. For many, avoiding stressful situations and stimulants is the only treatment necessary. But there are medications that can help. Drugs that affect your central nervous system are most commonly used.

Luckily for some folks, alcohol works. One man with essential tremor said: "I keep a small flask with me when I'm at a meeting and have to give a speech. I take a few sips a little while before I go 'on,' and my tremors subside enough so that I no longer find them distracting or embarrassing."

Beta blockers, normally used to treat high blood pressure, often work, as does Primidone, the antiseizure drug. Tranquilizers are sometimes prescribed, but medication in general provides relief for only about half the sufferers.

Then there's surgery. For that very small number of people whose tremors are disabling, there's a procedure for affecting a tiny part of your thalamus. It's a message center deep in the brain.

Dianne Zabel lived with essential tremor most of her adult life before she found out her nerve disorder was essential tremor. Ms. Zabel is an elementary-school teacher in Melbourne, Florida. Her tremor became so severe that in 1999, she underwent a procedure called deep brain stimulation. A Mayo Clinic neurosurgeon put tiny wire electrodes in her brain and attached them to a small battery-powered device implanted In her chest. In a week her tremors ceased, but essential tremor rarely becomes so severe as to necessitate this treatment.

Thus, shakiness that causes the clatter of a cup in its saucer (or the awkward lines in a once-steady or graceful signature) is not just a sign of getting old. Instead, there's a fair chance you are touched by essential tremor.

Try holding a sheet of paper in your hand and you probably will see your own hand tremble slightly, even if you don't have essential tremor. The reason is that your heartbeats and breathing have a ripple effect on the muscles of your body. Usually the trembles are very mild, unless you've guzzled several cups of coffee.

But for those with essential tremor, the trembles are different, continuing, and more noticeable. The use of the term "essential" means it is not linked to other diseases. One test commonly used to identify essential tremor is to have the patient draw a series of narrow concentric circles on a piece of paper starting at the center and keeping lines as regular as possible while the circle enlarges.

Try it yourself. If the lines are wavy and shaky the farther out the circle is enlarged, check with your physician. You may be among the five million people with essential tremor.

The National Institutes of Health has just opened a new Essential Tremor Centralized Brain Repository at Columbia University, a major step toward better treatment and, eventually. a cure for ET. Now doctors will be able to study what happens to the brains of people with essential tremor.

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