Essential Tremor: When to See a Neurologist or Psychologist?

Q: Essential Tremor: When to See a Neurologist or Psychologist?

Hello Benson： The essential tremor you mentioned is also known as primary tremor, where the exact cause of the tremor cannot be identified. <br>It may be due to a specific constitution or hereditary tremor. <br>Typically, individuals experience more tremors when holding objects,

Tremor issues

Hello Doctor: My hands have been shaking since I was young.
When I eat with a spoon or chopsticks, or when I use scissors or a utility knife, my hands tremble.
Recently, I've also noticed some shaking when holding objects or keys (though not every time).
Currently, it mainly affects me during exams when I have to mark cards, but otherwise, I feel it doesn't have a significant impact.
Last year, I went to the hospital for an examination, and the doctor diagnosed me with essential tremor.
The results were as follows: Thyroid Stimulating Hormone Immunoassay 1.28, Free Thyroxine Immunoassay 1.36, and 24-hour Mandelic Acid 2.94.
I checked my health records, and none of the results were above the normal range.
Could this be related to the unique constitution mentioned by the doctor at that time? I tend to be a rather anxious person, so I'm unsure if it could be psychological.
If I want to improve this condition, should I visit a neurologist or a psychologist?

Benson, 10~19 year old female. Ask Date: 2021/11/01

Dr. Jiang Junyi reply Neurology

Hello Benson: The essential tremor you mentioned is also known as primary tremor, where the exact cause of the tremor cannot be identified.
It may be due to a specific constitution or hereditary tremor.
Typically, individuals experience more tremors when holding objects, while some may tremble when writing or performing specific actions.
Clinically, Inderal (propranolol) can be used to alleviate symptoms.
Since it is related to one's constitution, a psychiatrist may not be able to help.
Tremors may worsen under stress.
It is also important to consider pathological tremors, which are caused by dysfunction of the nervous system, such as in Parkinson's disease, lesions in the midbrain, cerebellum, or basal ganglia, and metabolic abnormalities (such as hypoglycemia or hyperthyroidism).
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2021/11/01

More Info

Essential tremor (ET) is a common neurological disorder characterized by involuntary shaking, most often affecting the hands, but it can also impact the head, voice, and other parts of the body. It is important to understand the nature of this condition and when to seek help from a neurologist or psychologist.

From your description, it seems you have been diagnosed with essential tremor, which is often hereditary and can be exacerbated by stress or anxiety. The tremors you experience while using utensils or during exams are typical symptoms of ET. The fact that your thyroid tests came back normal suggests that your tremors are not due to a thyroid dysfunction, which can sometimes mimic or exacerbate tremor symptoms.

Given that you mentioned being a person who gets easily nervous, it is plausible that your anxiety could be contributing to the severity of your tremors. Stress and anxiety can amplify the symptoms of essential tremor, leading to a cycle where the tremors cause anxiety, which in turn worsens the tremors. This interplay between physical symptoms and psychological factors is crucial to understand.

When considering whether to see a neurologist or a psychologist, it is essential to evaluate the primary concerns you have. If your tremors are significantly impacting your daily life, such as during meals or while performing tasks that require fine motor skills, it would be advisable to consult a neurologist. They can provide a comprehensive evaluation of your condition, discuss potential treatment options, and help manage the physical symptoms of essential tremor. Treatment options may include medications such as beta-blockers or primidone, which can help reduce the severity of the tremors.

On the other hand, if you find that your anxiety about the tremors or other stressors in your life is becoming overwhelming, seeking help from a psychologist could be beneficial. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help you develop coping strategies to manage anxiety and reduce its impact on your tremors. Additionally, relaxation techniques, mindfulness, and stress management strategies can be effective in reducing the overall tension that may exacerbate your symptoms.

In summary, if your primary concern is the management of the tremors themselves, a visit to a neurologist is warranted. However, if anxiety and stress are significant issues for you, consulting a psychologist could provide valuable support. Ultimately, a multidisciplinary approach may be the most effective, where both neurological and psychological aspects are addressed. This could involve working with both a neurologist for the tremors and a psychologist for anxiety management, leading to a more holistic treatment plan.

It is also important to maintain open communication with your healthcare providers about your symptoms and any changes you notice. Keeping a journal of your tremors, noting when they occur and any associated feelings of anxiety, can provide useful information for your doctors. This collaborative approach can help tailor a treatment plan that best suits your needs and improves your quality of life.

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