Q: I am a 49-year-old male who was diagnosed with essential tremor about nine years ago. The symptoms seem to be getting worse, along with the addition of some numbness in certain areas like my left cheek arm and thumb. I also have continuous numbness above the knee on my left thigh.

My doctor suspected a pinched nerve in my neck but an MRI found nothing. I also mentioned a dull ache in my left armpit and under my shoulder blade but they found nothing. Just wondering where I should go from here.

A: Essential tremor (ET) refers to a neurological disorder that causes a rhythmic tremor or shaking. It can affect almost any part of the body, however it is most common in the hands, followed by the head, arms, legs and in the voice. While not harmful, it can worsen over time and may become severe. Signs and symptoms may be aggravated by stress, fatigue, temperature extremes and consuming caffeine.

It appears that almost half of all essential tremor cases are the result of a genetic mutation. The inherited form of this disorder is autosomal dominant, meaning that a defective gene from only one parent is needed to pass the condition on to offspring.

As you have apparently discovered, ET may become more pronounced as a person ages, yet this ET is not part of the natural aging process. The condition can occur at any age; however, it appears to most frequently strike either during adolescence or between the ages of 40 and 50. Approximately five million individuals in our country have essential tremor. Symptoms may worsen when the individual is confronted with a stressful situation. The voice may waver in tone, the head may nod, and in rare cases balance issues may occur. On the positive side, they lessen with rest.

While there is no cure for ET, there are methods of treatment that are designed to lessen symptoms and improve a person’s quality of life. As such, treatment may include oral medications such as Neurontin, Topamax and Mysoline. Or, drugs that contain tranquilizers may also be prescribed. Botox injections have been successfully administered to some patients for head tremors and vocal issues. Lastly, surgery is a viable option for a few. This procedure involves deep brain stimulation via the implant of electrical leads into the thalamus in the brain that are responsible for muscle control. Unfortunately, as with all medications or treatments, there is no one plan of treatment that works for everyone. It is up to the neurologist and his patient to determine what is correct in each instance.

I am unsure of the cause for your numbness since it isn’t a common symptom of essential tremor and the possibilities are many – yet, I’m leaning toward polyneuropathy, a chronic abnormal immune response. I don’t know the balance of your medical history or if you may have suffered any trauma that could be to blame. Speak with your physician to determine if any testing has been done to rule out the disorders mentioned, as well as carpal tunnel syndrome, and a B12 deficiency. Good luck.