Parkinsons Disease (PD) and Essential tremor (ET) both come under the broad category of movement disorders but they are not the same. In both conditions you can have a tremor and both can have non motor symptoms so they are often confused. Essential tremor is at least eight times more common than Parkinson’s disease and as many as 50% of people with ET are diagnosed wrongly with Parkinsons or some other disorder. Not long ago they thought ET was just a tremor problem but now they have proved people can get non motor symptoms with Essential Tremor. Having non motor symptoms and essential temor does not mean you have Parkinsons, you still have essential tremor.
We do know that some people with ET will go on to develop PD so it is possible to have ET with PD but people with Essential Tremor DO NOT automatically have Parkinsons as well and having Essential Tremor is NOT the same as having Parkinsons Disease. There are many differences but these differences are not always recognized by healthcare professionals and misdiagnosis or wrong diagnosis is common.
Recently they have shown that ET has other non motor symptoms like Parkinsons does. This makes it even easier for us to confuse the two. ET non-motor symptoms, include cognitive problems, depression, anxiety, balance problems, hearing impairment, sleep problems and problems with sense of smell. Advancements in neuroimaging have revealed widespread alterations in the brain of people with Essential tremor.
So what are some of the differences?
There are different types of tremor. The tremor in ET It is an action tremor, that is it is brought on by action, doing things. It mostly presents on both sides of the body. The tremor can affect the hands, legs, head, and voice and generally is first noticed during middle age, but can occur at any time of life including in children. In some people ET remains mild throughout their life and does not result in significant problems; however, in others ET progresses and their tremor gets worse making many daily activities very difficult or impossible.
Recently I was at a café and the man having his meal at a table nearby was having such a job to bring his spoon to his mouth, he shock violently every time he did and the spoon banged so hard against his plate the whole cafe could hear the noise. I had to admire him for his perseverance. If you shake when you do things it also makes it difficult to do up buttons, write legibly and many other activities that require fine motor skills.
The tremor of PD almost always starts on one side and is in the arms and legs and the chin/jaw. In Parkinsons the main symptoms are bradykinesia, (slow movement) rigidity (stiffness), resting tremor, and gait/balance issues. The average age of onset of PD is 60 years (so later than ET) although it may be much later and only about 10 percent present before the age of 40 years. Doing up buttons and writing is difficult not so much because you shake but because of stiffness and slowness. In PD the writing gets very small and that is often a prediagnosis sign. In ET the writing may be very untidy due to the shake which is a different problem than the pd stiffness problem.
Both ET and PD are affected by stress, anxiety and emotion and both types of tremor increase under stress.
People dont get diagnosed with ET AND PD at the same time so if you were told you had ET you would not be told you also had PD. There are lots of overlaps and it is not easy to tell the difference sometimes but if you listen carefully to peoples description of their symptoms and you watch how they progresss or not over time you can eventually tell one from the other.
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