Essential tremor assessment (Assessment of tremor (suspected essential tremor))
A specialist assessment to work out what is causing a tremor (shaking), to see whether it is essential tremor or another cause, and to discuss what, if anything, to do about it.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- The assessment works out what is causing a tremor – most often essential tremor, but sometimes Parkinson's disease, thyroid problems, medicines, or other causes.
- Essential tremor and Parkinson's can look similar and are often confused, so the examination and timing of the tremor matter; a scan is only needed in some cases.
- Essential tremor has no cure, but treatment can reduce it, and many people choose no treatment once reassured it is not dangerous.
- A diagnosis is usually clinical (from history and examination); ask what the diagnosis is based on and what it would change.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Clarifies what is causing the shaking, rather than leaving you guessing
A sudden, one-sided tremor or tremor with weakness, slurred speech or trouble walking, which needs urgent assessment rather than a routine clinic...
You talk through your symptoms and are examined. Many people are given a working diagnosis and an explanation of what it means the same day.
A clear explanation of the likely diagnosis, what it is based on, and how confident the specialist is.
You talk through your symptoms and are examined. Many people are given a working diagnosis and an explanation of...
Tests such as thyroid function are taken to exclude other causes. Results usually follow within days to a week or...
A DaTscan or other scan is arranged only when the cause stays unclear, and is reported separately, which takes...
Once the cause is clearer, you and the specialist discuss whether to do nothing, adjust lifestyle or medicines, or...
What is an essential tremor assessment?
An essential tremor assessment is an appointment, usually with a neurologist or a doctor with an interest in movement disorders, to work out why your hands, head or voice shake. The main aim is to decide whether the tremor is essential tremor, which is the most common cause, or whether it points to another condition such as Parkinson's disease, an overactive thyroid, a side effect of medicine, too much caffeine or alcohol, or, rarely, other neurological problems.
Most of the assessment is talking and examination. The specialist asks when the shaking happens, what makes it better or worse, whether anyone in your family has it, and how it affects daily tasks such as writing, eating and drinking. They then watch your hands at rest, with your arms held out, and during movements such as touching your nose or drawing a spiral, and check for other signs in your face, walking and balance.
The assessment gathers information so you can make a decision; it is not a treatment. Essential tremor cannot be cured, but it can often be helped, and many people decide they do not need treatment at all once they understand it is not dangerous. The assessment is also about ruling things out and explaining what the tremor is, and is not.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Essential tremor compared with Parkinson's tremor
| Feature | Essential tremor | Parkinson's tremor |
|---|---|---|
| When it shows | Mostly with movement or holding a posture | Often at rest, easing with movement |
| Sides affected | Usually both hands | Often starts on one side |
| Head/voice | Can affect head and voice | Less commonly head or voice |
| Other signs | Usually none | Slowness, stiffness, small steps |
| Alcohol | Often briefly reduces it | No reliable effect |
These patterns overlap and the two are often confused, so diagnosis depends on the whole picture rather than one feature. A scan is used only when the distinction stays unclear.
Preparing for your test
- Make a note of when the shaking happens (at rest, holding things, or during tasks) and what makes it better or worse.
- Bring a list of all your medicines and supplements, as some cause or worsen tremor.
- Note any family history of tremor or Parkinson's disease, as essential tremor often runs in families.
- Think about how the tremor affects daily tasks such as writing, eating, drinking and work.
- Note your usual caffeine and alcohol intake honestly, as both affect tremor and the assessment.
- If you can, bring a short phone video of the tremor at its worst, as it may not show during the appointment.
- Write down your questions, including what the diagnosis would change and whether treatment is worth it for you.
What happens
The specialist starts by asking about your tremor in detail: when it began, when it is worst, whether it affects one or both hands, your head or your voice, and whether anyone in your family has it. They will ask about caffeine, alcohol, stress and your medicines, because these all influence tremor.
They then examine you. They watch your hands resting in your lap, then with your arms held out in front, then during movements such as touching your nose or holding a cup, and may ask you to write a sentence and draw a spiral. They also look for other signs – slowness, stiffness, changes in your face, walking and balance – that would suggest Parkinson's disease or another cause.
Often the specialist can give you a working diagnosis the same day and explain what it means. Blood tests, usually including thyroid function, may be arranged to exclude other causes. A DaTscan or other scan is only suggested if it remains genuinely unclear whether the cause is essential tremor or Parkinson's disease. You should leave understanding what the tremor is, what it is not, and what the options are.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A sudden, one-sided tremor or tremor with weakness, slurred speech or trouble walking, which needs urgent assessment rather than a routine clinic appointment.
- As a way to obtain a brain scan when the history and examination already point clearly to essential tremor.
- As a substitute for reviewing medicines or thyroid function that may be causing the tremor.
- When the main problem is severe anxiety or another condition that should be addressed first.
Delay or rearrange if…
- You have a high caffeine intake or are very anxious on the day, which can temporarily exaggerate the tremor.
- You have recently started or stopped a medicine that affects tremor, so the picture may settle.
- You are acutely unwell, for example with a thyroid storm or infection, which should be treated first.
- Key information is missing, such as a medicines list or a record of when the tremor happens.
Alternatives to discuss
- Initial assessment by a GP, who can exclude common causes and refer if needed.
- A period of watchful waiting if the tremor is mild and not troubling.
- Reviewing or adjusting medicines and caffeine before specialist referral.
- Referral to a movement-disorder specialist if the diagnosis is unclear.
- Treating an underlying cause, such as an overactive thyroid, rather than the tremor itself.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Clarifies what is causing the shaking, rather than leaving you guessing
- Helps tell essential tremor apart from Parkinson's disease and other causes
- Identifies treatable contributors such as thyroid problems, caffeine or medicines
- Reassures many people that essential tremor, while annoying, is not dangerous
- Lets you make an informed choice about whether treatment is worth it for you
- Gives a baseline so any change over time can be judged
Risks & complications
- The tremor may not show during the appointment, so a phone video can help
- A clear single diagnosis is not always possible at the first visit
- Anxiety or caffeine on the day can temporarily worsen the tremor and the picture
- You may need blood tests or a follow-up to be sure of the cause
- Uncertainty between essential tremor and early Parkinson's that needs review over time
- An unexpected finding that leads to further tests
- Being referred on to a movement-disorder specialist for a clearer opinion
- False reassurance if an early or evolving condition is not yet apparent
- A DaTscan, if used, involves a small radiation dose and an injection
The assessment itself is talking and examination, so it carries no physical risk. The main uncertainty is diagnostic: essential tremor and Parkinson's disease overlap and are commonly confused, especially early on, so a confident label is not always possible at first. Ask what the diagnosis is based on, whether a scan would actually change anything, and what would prompt a review if things change.
Published figures to discuss
The assessment itself causes no physical harm, so the meaningful uncertainty is diagnostic rather than about complications. Essential tremor and Parkinson's disease overlap and are commonly confused, especially in the early stages, and a single examination cannot always separate them. Where it is used, dopamine-transporter (DaTscan) imaging is accurate at distinguishing the two, but it is reserved for genuinely uncertain cases rather than routine diagnosis. The figures below come from research and may not match every clinic or patient.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Misdiagnosis between essential tremor and Parkinson's disease | Reported in roughly 15–35% of movement-disorder cases in some studies | The two are the most commonly confused tremor diagnoses, which is why review over time is sometimes needed. | Distinguishing essential tremor from Parkinson's disease – PMCpmc.ncbi.nlm.nih.govPublished figure |
| Resting tremor present in essential tremor | Reported in about 1 in 5 (around 20%) of essential tremor cases | Overlapping features like this make a single examination less clear-cut than people expect. | Distinguishing essential tremor from Parkinson's disease – PMCpmc.ncbi.nlm.nih.govPublished figure |
| DaTscan accuracy (when used) for distinguishing the two | Sensitivity and specificity reported around 90% or higher in study settings | Accurate, but reserved for genuinely uncertain cases rather than routine diagnosis. | Distinguishing essential tremor from Parkinson's disease – PMCpmc.ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is nothing to recover from physically. What matters afterwards is being clear about the likely cause, whether any tests are pending, and what your options are if the tremor bothers you.
- No physical after-effects from the appointment itself
- A working diagnosis the same day in many cases, with some uncertainty being normal
- Waiting days to weeks for blood tests or a scan if these are arranged
- Mixed feelings – relief at reassurance, or worry while a diagnosis is confirmed
- Being asked to come back if the picture is unclear or the tremor changes
Aftercare
- Make sure you understand the likely diagnosis and what it is based on.
- Check whether any blood tests or a scan are pending, and how you will get the results.
- If you are reassured it is essential tremor, you do not have to have treatment – it is your choice.
- If you try a medicine for the tremor, follow the dose advice and report side effects.
- Keep a note of how the tremor affects daily tasks, which helps judge whether treatment is worthwhile.
- Know who to contact if the tremor changes noticeably or new symptoms appear.
- Ask about reliable sources of information rather than relying on clinic adverts for treatments.
- A note of when the tremor happens and what makes it worse
- An up-to-date list of your medicines and supplements
- A short phone video of the tremor at its worst
- Any family history of tremor or Parkinson's disease
- A list of daily tasks the tremor affects
- Your questions about diagnosis, scans and whether treatment is worth it
- Knowing how and when you will get any test results
⚠ Get urgent help if…
- A tremor that starts suddenly, especially on one side of the body
- Tremor with new weakness, numbness, slurred speech or trouble walking – seek urgent help
- Rapidly worsening shaking over days to weeks rather than slowly over years
- Tremor with a fast heartbeat, weight loss, sweating or feeling very unwell (possible thyroid problem)
- A severe headache, confusion or visual changes alongside the tremor
- Falls, or becoming unsteady on your feet
- Any symptom your clinician told you to treat as urgent
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a clear explanation of what is causing your tremor and what it means for you. For most people this is essential tremor – common, often familial, and not dangerous, even though it can be a nuisance. The specialist should explain how confident they are and what the diagnosis is based on.
A diagnosis of essential tremor cannot promise that the tremor will stay mild or never progress, and it does not rule out other conditions developing later, which is why review is sometimes advised. If the cause is genuinely unclear between essential tremor and Parkinson's disease, the honest answer may be that time, or a scan, is needed rather than a firm label on day one.
A tremor assessment reflects how things are at the time. Essential tremor often slowly worsens over many years, so a diagnosis and any plan may need reviewing as the tremor or its impact changes. If new features appear – such as slowness, stiffness or one-sided symptoms – the diagnosis may be revisited, since conditions can evolve and were not always apparent at first.
Related tests, treatments or support
A tremor assessment is often combined with blood tests, particularly thyroid function, and a review of your medicines. Where the distinction from Parkinson's disease matters, a DaTscan may be added. If treatment is considered, it may involve medicines such as propranolol or primidone, and in selected severe cases referral for procedures such as deep brain stimulation or focused ultrasound – which your specialist would discuss separately.
Follow-up & long-term care
After the assessment you should know the likely diagnosis, whether any tests are pending, and how you will get the results. If a medicine is started, a review checks whether it is helping and tolerated. If the diagnosis is uncertain or the tremor progresses, a follow-up lets the specialist reassess. You should be told who to contact if the tremor changes or new symptoms appear.
Repeat, follow-on and what comes next
- A working diagnosis may be revised as the tremor evolves or new features appear.
- Some people need a repeat assessment, blood tests or a scan before the cause is clear.
- If a treatment is tried, the dose or choice often needs adjusting, and not everyone benefits.
- An uncertain early picture is sometimes only resolved by reviewing how things change over time.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of the likely diagnosis, what it is based on, and how confident the specialist is.
- A plan for any pending blood tests or scan, and how results will be shared.
- Honest discussion that no treatment is reasonable for mild tremor, with options if it worsens.
- A named route to come back if the tremor changes or new symptoms appear.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The length and complexity of the appointment
- Whether it is with a general neurologist or a movement-disorder specialist
- Blood tests such as thyroid function, charged separately
- Whether a DaTscan or other scan is needed and who reports it
- Any follow-up appointments to confirm the diagnosis or review treatment
- Letters or reports requested for work or other purposes
- The specialist's consultation fee
- Whether blood tests are included or charged separately
- The cost of a DaTscan or other scan if it is needed, including reporting
- Whether a written report or letter is included
- The cost and timing of any follow-up appointment
- What happens, and what it costs, if the diagnosis is uncertain and review is needed
- The cancellation policy
On the NHS? Tremor assessment is available on the NHS when clinically indicated, often starting with a GP and referral to a neurologist; private assessment may be used for speed, choice or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Giving a firm label of essential tremor or Parkinson's disease without explaining the uncertainty.
- Ordering a brain scan that will not change management, or implying it is always needed.
- Not explaining that essential tremor has no cure and that no treatment is a valid choice.
- Not reviewing medicines, caffeine or thyroid function that could be causing the tremor.
- Not setting out what would prompt a review if the diagnosis is unclear.
Marketing red flags
- Promising a definitive tremor diagnosis from a single scan regardless of the clinical picture.
- Selling a brain scan as a routine part of assessing every tremor.
- Promoting a procedure such as focused ultrasound before medicines or proper assessment have been considered.
- Implying essential tremor can be cured rather than managed.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What do you think is causing my tremor, and what is that based on?
- How confident are you that this is essential tremor and not Parkinson's disease?
- Would a scan or blood test change the diagnosis or the plan?
- Do I need any treatment, and what would the realistic benefit and side effects be?
- What would make you want to review the diagnosis in future?
- Are there things I can change – like caffeine or certain medicines – that might help?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is essential tremor the same as Parkinson's disease?
Will I need a brain scan?
Can essential tremor be cured?
Why does alcohol seem to calm my tremor?
Do I have to have treatment if it is essential tremor?
Is a tremor assessment available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS Scotland Right Decisions – Essential tremor (GP factsheet) NHS – Tremor or shaking hands Distinguishing essential tremor from Parkinson's disease – PMC Managing essential tremor (review) – PMC Differentiating parkinsonism and essential tremor with FP-CIT SPECT (DaTscan) – PubMed
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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