For nearly three decades, Senator Susan Collins has been a fixture of the United States Senate, known for her moderate stance and enduring presence in Maine’s political landscape. But for the first time, the 73-year-old Republican is pulling back the curtain on a lifelong physical struggle that has, until now, been the subject of quiet speculation and online scrutiny.
On May 6, Sen. Collins revealed she has lived with essential tremor throughout her entire Senate career. The announcement follows a recent campaign video for her sixth-term bid, which sparked a wave of social media comments regarding the visible shakiness of her hands, head, and voice. In a move toward transparency, Collins clarified that the condition is managed with medication and does not impair her cognitive or professional capabilities.
“I have had it for the entire time that I have served in the United States Senate,” Collins told News Center Maine. “It has absolutely no impact on my ability to do my job or on how I feel each day.”
The disclosure arrives at a politically sensitive moment. As one of the most closely watched races in the current midterm elections, Collins’ campaign is navigating a landscape where age has become a central theme. The race has already shifted dramatically following the decision by Maine Governor Janet Mills, 78, to suspend her Senate campaign, leaving the Democratic nomination largely to 41-year-old newcomer Graham Platner.
More than just a shake: Understanding Essential Tremor
To the casual observer, a tremor is often conflated with more severe neurodegenerative diseases. However, medical experts describe essential tremor (ET) as a distinct movement disorder. Unlike tremors that occur while a person is sitting still, ET is an “action tremor,” meaning it manifests when a person is actively using their muscles—such as writing a letter, holding a glass of water, or speaking.
Dr. Elan Louis, a neurologist at UT Southwestern Medical Center, describes the condition as a “cousin” to Parkinson’s disease, though he notes it is significantly more common. Dr. Albert Fenoy, director of functional neurosurgery at Northwell Health, explains that the shaking is rhythmic and involuntary, often intensifying during moments of high stress or strong emotion.
The underlying cause of ET is linked to degenerative changes in the cerebellum, the region at the back of the brain responsible for coordinating movement. Specifically, researchers have identified the deterioration of Purkinje cells—a specific population of neurons—as the primary driver of the disorder. While the condition can appear at any age, its prevalence climbs sharply for individuals in their 50s, 60s, and 70s.
Essential Tremor vs. Parkinson’s Disease
Because the symptoms involve involuntary shaking, ET is frequently mistaken for Parkinson’s. However, the clinical differences are stark, particularly regarding when the tremor occurs and the overall prognosis.
| Feature | Essential Tremor (ET) | Parkinson’s Disease |
|---|---|---|
| Tremor Type | Action-based (occurs during movement) | Rest-based (occurs while idle) |
| Prevalence | Up to 20x more common than Parkinson’s | Less common |
| Progression | Sluggish (est. 1% to 2% per year) | Typically more rapid progression |
| Primary Impact | Motor coordination/shakiness | Complex motor and cognitive decline |
While Dr. Louis notes that people with ET have a four to five times higher risk of developing Parkinson’s than the general population, he emphasizes that the absolute risk remains remarkably low. The vast majority of ET patients will never develop Parkinson’s.
The cognitive debate and the “benign” label
For years, the medical community referred to the condition as “benign essential tremor,” a term Collins herself used in her announcement. The word “benign” was intended to signal that the condition is not life-threatening and does not typically lead to the profound cognitive collapse associated with other neurological diseases.
However, that terminology is shifting. Many clinicians have dropped the word “benign” because it minimizes the patient’s experience. Emerging research suggests a more complex relationship between ET and the brain. Dr. Louis points to data suggesting some patients experience mild cognitive difficulties, particularly with “executive function”—the ability to organize thoughts—and memory.
Some epidemiological studies indicate a 50% to 100% higher risk of developing dementia among those with ET. Despite these figures, experts stress that the absolute risk remains low, and cognitive changes are easily screenable through standard neurological testing.
Treatment and the social cost of visibility
Treatment for essential tremor varies based on the severity of the symptoms and the patient’s profession. Many people live with the condition without seeking intervention, but for those whose quality of life is impacted, several options exist:
- Medication: While no drug targets the tremor directly, doctors often prescribe heart-rate-reducing medications or anti-seizure drugs to slow the nervous system.
- Deep Brain Stimulation (DBS): Considered the “gold standard,” this involves implanting an electrode into the brain to block the faulty tremor circuit.
- Focused Ultrasound: A newer, incisionless procedure that uses ultrasound beams to create a lesion in the brain, effectively creating a “roadblock” for the tremor.
Beyond the physical symptoms, Dr. Fenoy highlights the “social stigmatism” associated with the disorder. The visibility of the shaking can lead to embarrassment and social withdrawal. Collins alluded to this struggle in her statement to the Associated Press, noting that her tremor has occasionally been the “subject of cruel comments online.”
Disclaimer: This content is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
As the midterm campaign intensifies, the focus on Sen. Collins’ health is likely to persist. The next major checkpoint for the race will be the formalization of the Democratic primary field and the subsequent debates, where the candidates’ respective health and ages may once again become a point of public discourse.
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