Non-essential tremor usually refers to involuntary shaky hands. With this condition, patients experience rhythmic shaking that is outside of their conscious control.
The hands are usually the most affected, but shaking can also occur in the legs, voice, and head. Tremors are more common during movement, but can also take hold when working against gravity.
Non-essential tremor is not itself a medical diagnosis. Usually, these tremors have some underlying cause, meaning they are related to another medical diagnosis. However, they can also be idiopathic, which is where doctors can't identify a cause.
It’s important to understand the difference between essential-tremor (ET) vs non-essential tremor. Essential tremor is a neurological tremor syndrome, often action-predominant and sometimes familial. Whereas ‘non-essential’ tremors arise from many other causes - medications, metabolic issues, Parkinson’s disease, cerebellar disorders, or others.
What is a Non-Essential Tremor?
Clinicians typically classify tremors by how they appear (rest, postural, kinetic/intention) and by cause (e.g., Parkinson’s disease, cerebellar disease, medications, metabolic disorders).
While ‘non-essential tremor’ isn’t a formal diagnosis it is often used to refer to “tremors that have an identifiable cause” versus essential tremor, which is often idiopathic (no clear cause).
Tremors can appear in varying circumstances. For example, action tremor is where the tremors occur during voluntary movements. This type of tremor encompasses kinetic tremor, where patients experience tremors during any part of the movement.
Intention tremor, on the other hand, is where the tremors worsen the closer the patient gets to their target. To illustrate this, someone with kinetic tremor would experience shaky hands throughout the process of taking the trash out, while someone with intention tremor would experience more shaking the closer they got to the garbage can.
Sometimes, the medical literature also refers to resting tremor. Unlike many non essential tremors, this happens when the body is at rest. If this occurs, doctors will often look for an underlying cause in the brain.
Finally, medics categorize postural tremor. This tremor emerges when the body is working against gravity in some way, usually when the arms are outstretched.
You may also encounter:
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Dystonic tremor (a consequence of dystonia)
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Cerebellar tremor (a type of tremor that occurs with damage to the cerebellum, part of the brain)
We discuss these in more detail below.
Types of Non-Essential Tremors
Tremor is a symptom a bit like sweating - many things can cause it. Therefore, doctors will usually tell you which type of non-essential tremor they think you have after carrying out various tests.
Physiologic & Enhanced Physiologic Tremor
Physiologic tremor is a normal part of being human. It refers to the invisible tremor everyone experiences as a consequence of being alive and having a nervous system.
Enhanced physiologic tremor is a common cause of postural (and mild kinetic) tremor, often brought on by caffeine, stress, sleep loss, certain medicines or anxiety. Usually, you can see this type of tremor occurring, often related to increased sympathetic nervous activity.
Parkinsonian Tremor
Parkinsonian tremor is a consequence of Parkinson's disease and is a part of the "resting tremor" category discussed above. It usually presents as rhythmic shaking of the hands and fingers (often asymmetric) that fades with action and may re-emerge when holding a posture.
Dystonic Tremor
Dystonic tremor occurs in people with dystonia and is often irregular and position-dependent. Orthostatic tremor is a different condition that causes rapid leg tremor while standing.
Doctors usually describe dystonic tremor as having "irregular" and "jerky" properties, where limbs don't coordinate as well as patients would like. Sometimes, the conditions can also be asymmetric, meaning it affects one side of the body more than the other.
Unfortunately, dystonic tremor frequency is not well understood. Scientists believe it may have something to do with the basal ganglia, which controls movement, but further research is needed.
Cerebellar (Intention) Tremor
Cerebellar (intention) tremor is identified on exam, worsening as the hand nears a target; MRI is used to look for causes like MS, stroke, or tumors. Usually, this tremor is coarse and low frequency and doctors will test for it by looking for brain abnormalities on CT or MRI scans.
Drug- or Toxin-Induced Tremor
Drug-induced tremor and toxin-induced tremors are caused by medications, alcohol withdrawal, and heavy metals.
The most common drug causes are antidepressants and immunosuppressants, which often cite tremors as a side effect. Toxins leading to tremors include lead, mercury, and some organic solvents.
Neuropathic Tremor
Finally, neuropathic tremor is linked to peripheral nerve damage, usually ranging between 3 and 6 hertz. Researchers believe it occurs due to impaired feedback between the extremities (e.g. the hands) and the rest of the body.
Non-Essential vs. Essential Tremor
The term "non-essential tremor" is not used often in the medical literature. However, it has come to mean any tremors that are not essential tremors.
Essential tremor usually causes symmetric shaking in the hands, but also the head and voice. It is most associated with action and often bilateral, being genetic in many cases. Non-essential tremor, however, can have multiple causes, as discussed below, including caffeine, alcohol, medications, and brain damage.
Causes of Non-Essential Tremor
Non-essential tremors aren't a single category, which means that they have numerous causes. This fact can make diagnosis more challenging, which is why it may take several visits to the doctor's office and multiple rounds of testing to determine the cause.
Neurological disorders
Sometimes, non-essential tremor can be caused by neurological conditions like Parkinson’s and multiple sclerosis. These diseases affect brain circuits, leading to difficulty holding the hands, voice and other parts of the body steady.
For example, Parkinsonian tremors are believed to arise from dopamine deficiency in the basal ganglia because of substantia nigra neuron degeneration. Unlike essential tremor, Parkinson's disease tremors reduce during voluntary movement.
By contrast, MS often leads to kinetic tremors that worsen during purposeful movement, often accompanied by tremor ataxia syndrome, which affects coordination.
Other neurological disorder diagnoses can also lead to non-essential tremors, including Wilson's disease, Huntington's disease, and spinocerebellar ataxias.
Metabolic issues
Metabolic disorders can also play a role in the development of non-essential tremor. For example, hyperthyroidism (an overactive thyroid) can increase sympathetic nervous system activation, causing more physiologic tremors in both hands. Other symptoms include weight loss, rapid heartbeat, and anxiety.
Liver failure can cause asterixis—a flapping negative myoclonus (brief loss of muscle tone) due to toxin buildup that affects brain function.
Also, non-essential tremor occurs in some patients with vitamin B12 deficiency. Lack of this essential nutrient can lead to systemic nerve damage, numbness, and weakness.
Medication side effects
Taking medications can also worsen non-essential tremor. These substances often interact with the nervous system (to deal with mental health disorders or other neurological issues), leading to side effects.
For example, SSRIs often produce an enhanced physiologic (postural) tremor, while antipsychotics may cause drug-induced parkinsonism with rest tremor and stiffness. These occur due to their drugs' effects on dopamine, serotonin and other neurotransmitters in the brain.
Central nervous system stimulants, like caffeine and amphetamines can have similar effects. These often lead to enhanced physiologic tremor due to increased sympathetic nervous system activation. Lithium for bipolar disorder may manifest in similar ways, leading to physiologic shaking and challenges with posture and fine motor control.
Finally, anticonvulsants like valproate, designed to reduce seizures, may induce postural tremors. These drugs attempt to block pathways that lead to seizures, but may have unwanted and off-target effects.
Injury or structural brain changes
Injury and structural brain changes can lead to various forms of non-essential tremor. The form shaking takes often depends on the brain region impacted.
For example, traumatic brain injury often affects the cerebellum and basal ganglia. Impacts in these regions make it more likely that intention, postural and rest tremor occurs. Similarly, stroke puts similar regions at risk, leading to tremor characteristics as the brain reorganizes.
Brain tumors can affect some patients, too. These often lead to unilateral tremors and associated symptoms, like headaches and weakness.
Finally, lesions in the brain and issues to do with cerebral vasculature can also lead to problems. These can disrupt neural pathways and lead to poorer communication with the periphery.
Diagnosis
Diagnosing non-essential tremor is (as mentioned in the introduction) challenging because it can have multiple causes. As such, physicians will often go through several tests to determine its origin (particularly if you don't have a pre-existing condition that would explain it).
Diagnosis often begins with a neurological exam. Neurologists will explore when the tremor occurs (i.e. during action or at rest), the frequency, and the amplitude. Understanding these variables allows them to pin down the most likely cause. For example, Parkinson’s disease usually produces a 4–6 Hz rest tremor, whereas enhanced physiologic tremor is typically faster around 8–12 Hz.
During this assessment, neurologists will also explore other neurological signs, like poor coordination, rigidity and dystonic postures. Looked at together, these provide more information about the underlying cause. Tests like the heel-to-shin and finger-to-nose are useful for evaluating movement quality and determining whether tremor worsens as it approaches its target.
Blood tests to determine metabolic causes are often the second step. The purpose of these tests is to screen for metabolic and systemic conditions that might lead to non-essential tremor. Panels often include vitamin and electrolyte levels, blood glucose measurements, and thyroid and liver function tests. Taken together, these can provide a profile of metabolic health indicative of an underlying condition that might lead to tremor.
Imaging (MRI, CT) can sometimes be helpful if a structural cause is suspected. MRI provides detailed images of the brain, particularly of cerebellar dysfunction, showing evidence of atrophy, tumors, and stroke. It can also reveal the demyelination caused by MS leading to action tremors.
CT is also sometimes used when MRI is not available. It can detect lesions caused by stroke or blood vessel damage, along with tumors.
Finally, shaky hands management can take the form of a medication review. Doctors will look for evidence of drug induced tremors from existing prescriptions by changing the frequency or dosage and looking for symptom improvements.
Treatment Options
Fortunately, there are many treatment options for non-essential tremor. Usually, these work by treating the underlying cause, such as Parkinson's medications or thyroid overactivity. Doctors may prescribe new drugs to improve symptoms or block thyroxine release.
Deep brain stimulation is another treatment option. This approach involves placing electrodes into the brain to deliver impulses and regulate nerve signals. It can be effective for various non-essential tremors, including Parkinson's.
Medics may also offer symptom relief via beta-blockers and anti-seizure meds. These help to reduce shaking directly by modulating nerve activity. Combined with physical therapy and occupational therapy, the benefits may be even greater.
Finally, lifestyle adjustments (reduce caffeine, stress) can help, too. Cutting down on morning coffees and working fewer hours may improve symptoms for many people.
Living with Non-Essential Tremor
Living with tremor can be a challenging experience even if you have a great doctor and are on the right medications. It can make many daily activities challenging, including eating, washing and getting dressed in the morning.
Fortunately, there are multiple strategies you can use to cope with non-essential tremor. Here's what to do:
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Identify any triggers, like caffeine or certain medications, and seek ways to avoid them or use alternatives
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Manage your stress levels by using whichever relaxation techniques work best for you
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Reduce the risk of fatigue by sticking to a regular sleep schedule
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Make tasks easier for yourself by using surfaces or furniture that stabilises your elbows and hands
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Do tasks requiring coordination at times of the day when your tremors are lower
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Stick to a healthy lifestyle
You can also use adaptive devices, like the VILIM ball. It is a next-generation, non-invasive handheld medical device — the first and only CE-marked solution specifically developed to reduce hand tremors with advanced AI technology. Its smart algorithms analyze each user’s tremor and personalize therapy in real time.
Built for people with Essential Tremor and Parkinson’s-related hand tremors, VILIM ball offers a modern, personalized approach to tremor management.
Finally, you may want to explore tremor help groups and resources. Good places to start include the International Essential Tremor Foundation and The Parkinson's Foundation.
When to See a Doctor
If you experience sudden onset tremor, you should see a doctor. These symptoms could indicate a stroke or serious issues with your medication.
You should also see a doctor if you notice:
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Tremor with weakness (indicative of a stroke)
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Speech problems (also indicative of a stroke)
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Other neurological symptoms (trouble with coordination)
Conclusion
In summary, tremor doesn’t always mean serious illness. It can just indicate stress or that you're on the wrong medications.
Non-essential tremor has many causes. Essential tremor is a single diagnosis but its underlying cause isn’t fully understood.
If you think you have non-essential tremor, go for a professional evaluation for proper diagnosis. Often, you can manage symptoms or remove the cause of the shaking, improving your quality of life.
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