When a Shaking Hand Isn’t Parkinson’s – And How to Stop the Shaking

Dr. Frank Shallenberger, MD
October 22, 2018


If your hand routinely shakes when you hold a drink, sign your name, or tap a number into your cell phone, you may fear that you’re on the way to Parkinson’s disease. But what you’re more likely to have is something that has nothing to do with Parkinson’s.

It’s called essential tremor. Roughly, 10 million people in the U.S. have essential tremor according to the International Essential Tremor Foundation. Essential tremor is a common neurological condition that causes tremors of the hands during movement, and can also affect the head, voice, or legs.

Unlike Parkinson’s, which is a degenerative disease that causes someone to lose brain cells, essential tremor is not a degenerative disorder. According to Dr. Michael Rezak, director of the Movement Disorders Center at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois. “Essential tremor results from a malfunction of certain neurons, but you don’t lose brain cells, and you don’t lose gait or balance.”

Usually, essential tremor happens when performing a movement-oriented activity such as eating, drinking, writing, typing or brushing teeth. The severity can range from a barely noticeable trembling to a severe, disabling tremor that has a significant impact on the ability to perform everyday activities. The tremors are aggravated by anxiety, fatigue, caffeine, and some medications. Remember Katharine Hepburn? Her condition was an example of advanced essential tremor affecting her voice, head and arms, as well as her hands.

If your parents had essential tremor, there’s a 50:50 chance you will get it. The biggest problem with essential tremor is that it typically gets worse as you get older.

What About Treatment?

Probably, the best single treatment for relatively mild cases is the drug propranolol. Propranolol is a beta-blocker drug that can decrease the tremors for about three to four hours. It’s no cure, but it’s safe and can help with the symptoms.

For more significant cases, researchers have recently developed a new noninvasive MRI-guided high-intensity ultrasound technique called magnetic resonance-guided focused ultrasound thalamotomy. Try to say that real fast.

This treatment uses concentrated ultrasound waves to selectively ablate the part of the brain that contributes to tremors. “It’s a one-time treatment,” says Dr. Ali Rezai, director of the Neurological Institute at The Ohio State University Wexner Medical Center. Just this month researchers reported on a review of 37 patients who underwent the procedure.

They found that after one year their tremors were still improved from 27.8 to 59% and holding. It’s a modest improvement at best, but these were severe cases where even a modest improvement can make a big difference in quality of life. The authors did not report any significant side effects.

But, what if your symptoms are not bad enough to warrant the ultrasound procedure? Here are some less invasive ideas that have worked for many of my patients over the years.

The First Treatment May Seem Surprising

It’s resistance training. I first learned about it a couple of years ago when researchers reported on a study that looked at 10 men and women with essential tremor. First, they tested all of them with a battery of manual dexterity and isometric force tremor assessments. Then, then put them through a six-week program of resistance training that focused on their arms, hands, and shoulders. At the end of the six weeks, they found that the stronger the patients had become, the more improvement was seen with their tremors. The researchers concluded that, “These findings suggest that a generalized upper limb resistance training program has the potential to improve aspects of manual dexterity and reduce force tremor in older essential tremor patients.”

The other thing that has worked well for me is a combination of magnesium, B-vitamins, the herb mucuna pruriens, and the medication selegiline. The best way to start the magnesium and B-vitamins is with intramuscular injections (1,000 mg of magnesium sulfate, 1 cc of B-complex, and 2 cc of 2% procaine) once a week for four weeks. During that time, take selegiline 5 mg once a day (you’ll have to get a prescription from your doctor) and 100-500 mg of mucuna pruriens (extracted to 99% L-dopa). You can get the mucuna extract online.

Selegiline is an anti-aging drug that has been around for many years. And the Mucuna extract contains the amino acid L-dopa. All of these treatments are completely safe. And while they don’t always work, they are definitely worth a try. They are not a cure. As soon as you stop them, the tremors will come back. If the magnesium and B-vitamin injections work well, you can try switching to capsules.


Meng Y, Solomon B, et al. Magnetic resonance-guided focused ultrasound thalamotomy for treatment of essential tremor: A 2-year outcome study. Mov Disord. 2018 Oct 4.

Kavanagh JJ, Wedderburn-Bisshop J, Keogh JW. Resistance Training Reduces Force Tremor and Improves Manual Dexterity in Older Individuals With Essential Tremor. J Mot Behav. 2016;48(1):20-30.

The Truth About Essential Tremor: It’s Not Just a Case of Nerves, Stacey Colino • Nov. 11, 2015, at 9:50 a.m.



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