Public speaking for any aspiring MP during an election campaign can be nerve-racking, but Oscar Reaney’s shaking hands as he stood (unsuccessfully) as the Conservative candidate in Bethnal Green and Stepney in London this year were nothing like that.
“People think I must be really nervous when I shake, but I have to explain to them that I’m actually a confident speaker and I shake for no apparent reason,” he explains.
“It happens all the time, but it’s most noticeable in social situations – receptions where I have to hold a glass firmly or shake hands with a lot of people can be difficult.”
Oscar Reaney, who stood for Conservative MP for Bethnal Green and Stepney
Oscar first noticed his hands shaking as a teenager living in Eckington, Derbyshire. “I was just 14 when my left hand started shaking. I would spill coffee and people would ask me why I was so nervous,” he recalls.
Even Oscar’s parents attributed it to social anxiety, and no one, including him (nor his twin brother Cristian, who also developed a mild tremor), thought to consult a doctor.
“It was never a problem at school, but as I got older people sometimes assumed it was because of the alcohol, which was annoying, especially as I hadn’t been drinking. If I had a pound for every person who told me to ‘calm down’ and ‘stop shaking’, I’d be a rich man.”
At age 20, Oscar’s tremors (who at 24 became the youngest councillor in his local district) gradually worsened, affecting both hands, then his legs and jaw.
“Board meetings can be quite heated and I found that if I got nervous my arms and sometimes my legs would shake,” he explains. “Sometimes when I was really stressed my jaw would shake as well and that would affect my voice.”
Following the COVID lockdowns in 2020, Oscar moved to London to be a parliamentary assistant to an MP. At this point, his symptoms began to affect his work, as note-taking was sometimes difficult, so he had to use a laptop. His symptoms also seemed to worsen with socialising.
“My friends would ask me if I wanted to go to the bar after work and my mind would immediately go into panic mode,” Oscar says. “That was my lowest point.”
Researching his symptoms online, Oscar stumbled upon essential tremor, a movement disorder affecting one million people in the UK that causes involuntary rhythmic shaking in one or both arms or legs (and, less commonly, in the jaw or head, tongue and voice). He consulted his GP, who confirmed the diagnosis.
“After years of symptoms, it was a relief to know what was causing it,” Oscar says.
Essential tremor is the most common movement disorder, eight to ten times more common than Parkinson’s disease, although it is much less well known.
Symptoms can be quite distinctive and different from those of Parkinson’s or other causes of tremor: Essential tremors tend to be related to actions, such as writing or eating, for example, while Parkinson’s tremors are worse at rest.
Tremors may also be made worse by stress, fatigue, hunger, heightened emotion, or extreme temperatures.
It is often misdiagnosed and wrongly attributed to anxiety or excessive alcohol consumption, which is why the condition can be “highly stigmatising and probably underreported”, says Dr Tom Gilbertson, consultant neurologist at Ninewells Hospital in Dundee.
“We don’t know exactly why the symptoms occur, but it’s possible that the hormone adrenaline, released when the body is in ‘fight or flight mode,’ affects muscle oscillation in the body’s peripheral muscles,” he explains.
This may be due to a disruption in communication between different parts of the brain, particularly the networks of the cerebellum, the area that controls movement.
Although there is no diagnostic test, a DaTscan of brain function (which examines brain function rather than structure, as an MRI does) can help distinguish essential tremor from Parkinson’s.
The symptoms can have a huge impact on people’s lives – they may avoid eating out or speaking in public. Some are unable to fasten buttons or zippers so cannot dress themselves, while others may have to give up their job.
Downton Abbey creator Julian Fellowes, who first experienced symptoms in his late 50s, told a podcast that his tremors were so severe that at one point he threw a glass of wine over his face during dinner with a famous Hollywood producer.
Coronation Street actor Rob Mallard has also spoken publicly about his essential tremor, which began at age 14 and now affects his hands, arms, neck and sometimes his voice.
A survey by the National Tremor Foundation found that one in four patients said their tremor had affected their work life. More than half said their symptoms had also caused mental health problems.
Although the disease is more common in older people, affecting one in 20 people over the age of 60, symptoms can also often begin in the teens and early 20s, but “it can be difficult to diagnose in younger people until symptoms become more pronounced,” says Dr. Gilbertson.
Once diagnosed, techniques such as mindfulness meditation can be helpful for mild symptoms by controlling the fight-or-flight response and the adrenaline released, says Dr. Gilbertson.
‘Drinking an alcoholic beverage, within safe limits, before social situations can also calm some people’s mood.’
Drug treatments include beta-blockers such as propranolol, which affect the release of adrenaline and reduce tremors, or epilepsy medications such as primidone, which modify chemical transmission in the brain.
Less commonly, in cases of head tremors, botulinum toxin (Botox) injections may be used to “freeze” the affected trembling muscle.
Other treatments available on the NHS include deep brain stimulation (DBS), where electrodes implanted in deep structures of the brain create a new electrical current that can short-circuit the tremor as messages pass through the brain and reach the muscle.
The procedure is generally “very safe,” but the risk is higher in patients with multiple health problems, such as heart disease or cognitive dysfunction, Dr. Gilbertson says.
A newer, less invasive NHS treatment for those patients who are not suitable for DBS is MRI-guided focused ultrasound, currently available in London, Liverpool and Dundee (although it is also available privately and costs around £25,000).
In this case, a three-dimensional frame is placed on the patient’s head and then four to six 10-second bursts of ultrasound are applied to the thalamus (the area involved in involuntary movement). A study of 40 patients who received this treatment found that the severity of their tremors had been reduced by 70 percent five years later, the Journal of Neurosurgery reported in 2022.
However, this ultrasound method is not suitable for everyone, particularly those with mobility issues, as balance problems are a possible side effect. Others include numbness and speech problems.
The overall message is that “people no longer have to endure the shaking – something can now be done about it,” says Dr Gilbertson. “It’s an opportunity to restart their lives.”
Reluctant to take medication, Oscar currently relies on self-care techniques to control his tremors.
She’s also cut out caffeine and sugary drinks (which she’s found make things worse) and avoids serving drinks at receptions “so I don’t have to spill them.”
She added: “It is reassuring to know that there are now other, newer treatments available should they be needed in the future.”