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Essential Tremor Or Parkinson's: Here's How To Tell The Difference · Tremor & Parkinson's Surgery Explained with Dr. Wu

• 0:00
  SPEAKER_00: If your hand has started shaking, don't assume it's Parkinson's disease.
• 0:04
  SPEAKER_00: It might be, it might not.
• 0:05
  SPEAKER_00: I'm a neurosurgeon and I treat both essential tremor and Parkinson's disease.
• 0:10
  SPEAKER_00: And the first thing we have to do is diagnose it properly.
• 0:13
  SPEAKER_00: Because without the right diagnosis, you can't get the right treatment.
• 0:17
  SPEAKER_00: So let me walk you through the same things we look for to tell Parkinson's apart from essential tremor.
• 0:23
  SPEAKER_00: The first thing we look for is when the shaking happens.
• 0:26
  SPEAKER_00: Not necessarily how bad it is, not how long you've had it, but when does it happen?
• 0:30
  SPEAKER_00: Does it show up when you're trying to do something or when you're doing nothing at all?
• 0:34
  SPEAKER_00: If the shaking happens while someone is trying to use that hand, that generally points us towards a central tremor.
• 0:40
  SPEAKER_00: Picture a shopping cart, one with a wobbly wheel.
• 0:44
  SPEAKER_00: Sitting still, everything looks fine.
• 0:45
  SPEAKER_00: But once you start pushing it, especially if you're trying to steer really carefully down a narrow aisle, that wheel starts shaking.
• 0:52
  SPEAKER_00: A central tremor works in a similar way, mostly a calm hand when doing nothing, though some patients, a small number, feel a little shaky even at rest.
• 1:02
  SPEAKER_00: And then the hand becomes shaky the moment someone tries to sign a check or bring a spoon of soup to their mouth or button a shirt.
• 1:09
  SPEAKER_00: And the thing is, the harder you try to control it, the worse it gets.
• 1:13
  SPEAKER_00: So this is why patients generally tell me the same three or four stories over and over again.
• 1:18
  SPEAKER_00: Handwriting that's gotten so bad, they can barely read it themselves, usually big wavy letters that get harder to control the longer they write.
• 1:26
  SPEAKER_00: Avoiding restaurants because that spoon of soup never actually makes it to their mouth cleanly.
• 1:31
  SPEAKER_00: And sometimes buttoning a shirt can turn into a 10-minute job.
• 1:34
  SPEAKER_00: And that's why it feels so frustrating, right?
• 1:36
  SPEAKER_00: The harder you try to steady your hand and the smaller the movements you try to make, the worse the tremor gets.
• 1:42
  SPEAKER_00: Now, with Parkinson's, the tremor shows up while the hand is resting, sitting in your lap, hanging by your side, when you're doing nothing at all.
• 1:49
  SPEAKER_00: Then the moment you reach for a cup or pick up your phone or try to do something, it can settle down or may even disappear.
• 1:56
  SPEAKER_00: Though if you're holding a specific pose, it can creep back in, like when you're holding out your arm for a few seconds.
• 2:02
  SPEAKER_00: And in terms of writing, instead of big wavy handwriting, Parkinson's patients tend to shrink it.
• 2:08
  SPEAKER_00: Letters that start normal in size and get smaller and smaller as you write.
• 2:11
  SPEAKER_00: Parkinson's tremor is usually associated with a specific rhythm as well, about three to six times a second, what we call a pill rolling tremor because the thumb and the fingers move like they're rolling a tiny pill between them.
• 2:22
  SPEAKER_00: You can't sit still when you want to sit still, and when you need the hand to work, it actually behaves.
• 2:27
  SPEAKER_00: So these tremors seem pretty different, right?
• 2:29
  SPEAKER_00: Pretty straightforward to diagnose one from the other.
• 2:32
  SPEAKER_00: Well, if the diagnosis were that simple, we'd stop there.
• 2:34
  SPEAKER_00: But we don't, because when it happens tells us a lot, but it doesn't tell us everything.
• 2:39
  SPEAKER_00: We also want to look at where the shaking shows up, where in the body that is.
• 2:43
  SPEAKER_00: Essential tremor usually stays in the hands and arms, but it can also show up in the voice or the head.
• 2:48
  SPEAKER_00: And I've had patients whose real problem actually wasn't their hands at all.
• 2:52
  SPEAKER_00: It was that their voice shook every time they got on the phone or their head would nod up and down or left to right.
• 2:58
  SPEAKER_00: Now Parkinson's rarely does that.
• 3:00
  SPEAKER_00: Head of voice tremor generally points us towards essential tremor, not Parkinson's.
• 3:04
  SPEAKER_00: And when Parkinson's does show up in the face, it's usually limited to the jaw or chin, not the entire head shaking side to side or up or down.
• 3:12
  SPEAKER_00: Parkinson's, on the other hand, is more likely to involve the legs in a way that essential tremor usually doesn't.
• 3:18
  SPEAKER_00: There's also the question of involving both sides versus just one side.
• 3:22
  SPEAKER_00: Essential tremor tends to show up in both hands at about the same time and roughly evenly.
• 3:28
  SPEAKER_00: Whereas Parkinson's almost always starts on one side, one hand or one foot before it gradually progresses to the other side.
• 3:35
  SPEAKER_00: So if a tremor is stubbornly one-sided or clearly worse on one side when it starts, that generally leans us towards Parkinson's.
• 3:43
  SPEAKER_00: But if both hands are shaking at about the same time at about the same amount from day one, that leads us to a central tremor.
• 3:50
  SPEAKER_00: Again, those are gross generalizations and there are always exceptions to the rule, but this pattern of onset can help us with the diagnosis.
• 3:58
  SPEAKER_00: Another thing that can help a little is how the tremor is affected by stress.
• 4:01
  SPEAKER_00: Both tremors can get worse under stress, but for central tremor patients, they tend to notice it more.
• 4:06
  SPEAKER_00: A tense phone call, a crowded restaurant, standing up to speak, all of it turns up the volume of movements they're already struggling with.
• 4:13
  SPEAKER_00: Meanwhile, Parkinson's tremor can worsen with stress as well.
• 4:17
  SPEAKER_00: It's just often less obvious since the tremor is already settling down the moment the hand goes to work.
• 4:23
  SPEAKER_00: And it may actually be the other symptoms of Parkinson's besides tremor that may worsen more with stress.
• 4:28
  SPEAKER_00: So unfortunately, stress isn't an entirely clean way to tell the two apart on its own.
• 4:33
  SPEAKER_00: It's just one more piece of the puzzle.
• 4:35
  SPEAKER_00: Then there's another clue that most people will never actually think about alcohol.
• 4:40
  SPEAKER_00: A lot of essential tremor patients notice that a single drink calms their hand down, sometimes dramatically, for an hour or two.
• 4:46
  SPEAKER_00: It's actually one of the classic signs we look for.
• 4:48
  SPEAKER_00: Meanwhile, Parkinson's tremor doesn't respond to alcohol that way at all.
• 4:52
  SPEAKER_00: So if someone tells me their tremor all but disappears after a glass of wine or a beer, that puts me towards essential tremor more so than Parkinson's.
• 5:01
  SPEAKER_00: And medication can tell us a similar story.
• 5:03
  SPEAKER_00: Essential tremor and Parkinson's tremor often respond completely different to different drugs.
• 5:08
  SPEAKER_00: And unfortunately, some tremors barely respond to anything at all.
• 5:12
  SPEAKER_00: Then we zoom out and ask, is the tremor the only problem?
• 5:15
  SPEAKER_00: Because Parkinson's usually doesn't show up as just a tremor.
• 5:19
  SPEAKER_00: Now, quick thing before I keep going, if any of this is sounding useful, either for you or for someone in your family, and tell me which one you think you have and any questions you might have.
• 5:29
  SPEAKER_00: I'll do my best to read all of these, and your comments can certainly help me know what to cover next.
• 5:33
  SPEAKER_00: Alright, let's get back to it.
• 5:35
  SPEAKER_00: Parkinson's doesn't just show up as a tremor.
• 5:37
  SPEAKER_00: It often comes with other movement problems too, things like stiffness, slower movement, what we call braidokinesia, or changes in the way someone walks.
• 5:45
  SPEAKER_00: And central tremor, on the other hand, is usually just that, a tremor.
• 5:49
  SPEAKER_00: A smaller group of patients have some mild extra signs alongside it, but by and large, if it's a central tremor, the tremor is the whole picture.
• 5:58
  SPEAKER_00: Now, everything we've covered so far can build a pretty good picture, but here's where it can get complicated.
• 6:03
  SPEAKER_00: What if someone has both a central tremor and Parkinson's?
• 6:06
  SPEAKER_00: Now, some people genuinely have both.
• 6:08
  SPEAKER_00: One tremor that shows up with movement and another that shows up at rest, living in the same hand.
• 6:14
  SPEAKER_00: And unfortunately, I've had patients who were first diagnosed with essential tremor, and years later, they were diagnosed with Parkinson's too.
• 6:21
  SPEAKER_00: So even a strong picture can shift over time.
• 6:24
  SPEAKER_00: That's exactly why a doctor may need to keep gathering evidence instead of stopping at the first good answer.
• 6:29
  SPEAKER_00: But we're still not done.
• 6:30
  SPEAKER_00: A neurologist also has to make sure it isn't a completely different kind of tremor.
• 6:34
  SPEAKER_00: Some tremors actually come from a stroke, a tumor, or other damage that disrupts connections to part of the back of the brain called the cerebellum.
• 6:43
  SPEAKER_00: Doctors call this a Holmes tremor, and this used to be called a rubral tremor.
• 6:47
  SPEAKER_00: It's just an older name for the same thing, not a separate condition.
• 6:51
  SPEAKER_00: Now, what makes it unusual is that it doesn't pick one pattern the way that a central tremor or Parkinson's does.
• 6:57
  SPEAKER_00: It can show up at rest when the arm is held out, and also when reaching for something.
• 7:02
  SPEAKER_00: It also tends to look different up close, slower and heavier than the other two, with big swinging movements rather than a fine shake.
• 7:09
  SPEAKER_00: So a much larger tremor.
• 7:11
  SPEAKER_00: Now, if a central tremor usually shakes at about four to eight times a second and Parkinson's a little slower, like I mentioned before, at three to six times a second, a Holmes tremor is slower still, usually less than four times each second.
• 7:25
  SPEAKER_00: That slower speed is part of why it looks so different from the other two.
• 7:28
  SPEAKER_00: So with all these clues that we can gather, is there anything that confirms it outright?
• 7:33
  SPEAKER_00: Well, that would be too easy.
• 7:35
  SPEAKER_00: We do have another tool to help with the diagnosis, and it's called a DAT scan, short for dopamine transporter scan.
• 7:41
  SPEAKER_00: Think of it like checking a fuel gauge on the specific brain cells that produce the neurotransmitter dopamine.
• 7:46
  SPEAKER_00: In someone with a central tremor, that gauge reads normal.
• 7:50
  SPEAKER_00: But in someone with Parkinson's, it reads low.
• 7:52
  SPEAKER_00: Most patients don't actually need one since careful exam usually gets us there, but a DAT scan can provide a final piece when the diagnosis is still not clear.
• 8:01
  SPEAKER_00: One caveat though, it can confirm that dopamine cells are involved, but unfortunately, it can't tell Parkinson's apart from a few rarer conditions that look similar and are also because of loss of dopamine cells.
• 8:13
  SPEAKER_00: So if you or someone you love has a tremor, this is generally the process that a neurologist or movement disorder specialist will walk through.
• 8:21
  SPEAKER_00: Timing, location, effective alcohol, effective medication, ruling out other causes, and confirming with a scan if needed.
• 8:28
  SPEAKER_00: So get in front of a specialist who can actually run through that process in person.
• 8:31
  SPEAKER_00: Now, what comes next, whether it's treatment with medication, watching it closely, or eventually talking about procedures like deep brain stimulation or focused ultrasounds, things that I do, that depends on getting the diagnosis right first.
• 8:44
  SPEAKER_00: Now, say you already know.
• 8:46
  SPEAKER_00: If someone just told you and diagnosed you with Parkinson's disease and know that it's not a central tremor, that's a whole different set of questions.
• 8:53
  SPEAKER_00: So what do you do first?
• 8:54
  SPEAKER_00: Can anything be done to slow down the progression of Parkinson's disease?
• 8:58
  SPEAKER_00: What actually changes for you starting today?
• 9:01
  SPEAKER_00: That's in my next video.
• 9:02
  SPEAKER_00: So stay with me for that one.
• 9:03
  SPEAKER_00: Until next time.
• 9:05
  SPEAKER_00: Bye.