Essential Tremor vs Dystonic Tremor -Understanding the Differences

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Tremors, characterized by involuntary and rhythmic shaking, can significantly impact an individual’s life. Among the various types of tremors, essential tremor and dystonic tremor are common yet distinct conditions. While they may share some superficial similarities, understanding their differences is crucial for accurate diagnosis and effective management.

This article explains the key dfferences between essential tremor and dystonic tremor, shedding light on their unique characteristics and treatment approaches.

Essential Tremor vs Dystonic Tremor

Essential tremor

Often misconceived as a part of aging, essential tremor is a neurological disorder that primarily causes a rhythmic shaking of the hands, head, voice, or other body parts. Unlike tremors caused by Parkinson’s disease, essential tremor typically occurs during voluntary movements and can worsen with stress or fatigue.

The exact cause of essential tremor is not fully understood, but a genetic component is often involved. The severity and progression of essential tremor can vary, with some individuals experiencing a gradual increase in tremor amplitude over time.

Dystonic tremor

This type of tremor is associated with dystonia – a movement disorder characterized by involuntary muscle contractions. Dystonic tremor can occur in the same body part affected by dystonia or in other areas, and it often presents as an irregular, jerky tremor.

Dystonic tremor can significantly affect specific tasks and activities, depending on the muscles involved. Its presentation can vary greatly, making it a challenge to diagnose and manage.

Differences in key features between essential tremor and dystonic tremor

Symptoms and presentation

Essential tremor is characterized by a rhythmic, back-and-forth motion that is typically most evident during activities requiring fine motor skills, such as writing, drinking from a cup, or using utensils. The tremor in essential tremor is generally symmetrical, affecting both sides of the body in a similar pattern. It often starts subtly and can gradually increase in amplitude over time. The voice may also be affected, resulting in a trembling sound when speaking.

In contrast, dystonic tremor tends to be more irregular and less rhythmic. It often presents alongside dystonic movements or postures, where the affected body part may twist, turn, or take on an abnormal posture involuntarily. This type of tremor may not be as constant as essential tremor; it can appear and disappear, often exacerbated or triggered by specific movements or positions. Dystonic tremor is also more likely to be asymmetrical, affecting one side of the body more than the other. In some cases, the tremor can be task-specific, occurring only during certain actions, like writing or speaking.

Triggering factors

Essential tremor typically becomes more noticeable during purposeful movements such as eating, drinking, or writing. It may also intensify under conditions of emotional stress, fatigue, or with substances like caffeine, which can stimulate the nervous system.

Dystonic tremor, in contrast, is closely linked to the positions or postures assumed by the affected body parts. It may manifest when holding a specific posture or during certain actions, and the intensity can fluctuate depending on the body’s position or the specific task being performed. This tremor may occasionally lessen or disappear completely at rest, a characteristic less commonly observed in essential tremor.

Affected areas

Essential tremor most frequently involves the hands, making tasks that require fine motor skills challenging. It can also affect the head, causing nodding or shaking movements, and the voice, leading to a quivering sound when speaking.

Dystonic tremor, on the other hand, is more variable in its location. It can affect any muscle group impacted by underlying dystonia. This includes the neck, resulting in cervical dystonia with characteristic tilting or turning of the head, the limbs, which may exhibit twisting or abnormal postures, and even the facial muscles, leading to involuntary facial movements or expressions. The distribution of tremors in dystonic tremor is often asymmetrical and can be localized to the area of the dystonia.

Differences in treatment approaches

Treating essential tremor

Treatment for essential tremor may include beta-blockers like propranolol and primidone, an anti-seizure medication. These drugs can reduce tremor severity and improve functionality. In cases where medication is ineffective, surgical options such as deep brain stimulation (DBS) may be considered. Lifestyle changes, like reducing caffeine intake and employing stress management techniques, can also help mitigate tremor symptoms.

Treating dystonic tremor

The treatment approach for dystonic tremor often involves addressing the underlying dystonia. Botulinum toxin injections are commonly used to target specific muscles affected by tremor and dystonia. Medications that address muscle spasms and neurological symptoms, including anticholinergics or muscle relaxants, can also be effective. Physical therapy is crucial for managing muscle contractions and improving movement patterns. In severe cases, surgical interventions like DBS may be explored.


Understanding the distinctions between essential tremor and dystonic tremor is vital for accurate diagnosis and effective treatment. Though they share some similarities, their differences in symptoms, triggering factors, and affected areas necessitate distinct approaches to management. By embracing a combination of medical treatments, lifestyle adjustments, and supportive resources, individuals with either condition can lead fulfilling lives despite the challenges of living with tremors.

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