Essential tremor (ET) is a common movement disorder. It is also known as idiopathic tremor and benign tremor. The disease was first described by Dana in 1887, and for more than 100 years, despite extensive research on its etiology, pathogenesis, clinical features, diagnosis and treatment, it is still difficult to diagnose and no very effective treatment is available. In order to improve the understanding of this disease, we would like to briefly outline the mechanism of occurrence, clinical features, diagnosis, differentiation, treatment and basic research of this disease. Differentiation and diagnosis of primary tremor and Parkinson’s: the disease most easily confused with ET clinically is PD or Parkinson’s syndrome. Some scholars found that there is a high percentage of ET prevalence in the families of PD patients; at the same time, there is a high percentage of ET-PD in ET, and often the onset of ET precedes that of PD; so some scholars thought that ET is a kind of PD stroke-type. However, many scholars have studied that ET and PD are two different diseases. The clinical differentiation depends mainly on the form of tremor and neurological signs; PD can have motor tremor, although resting tremor is more typical. Resting tremor can be seen in different parts of the body, often asymmetrically, with the most typical manifestation being a pill-rolling movement. It is caused by elbow flexion and extension movements, anterior and posterior rotation of the forearm, and thumb movements at a frequency of 4-6 Hz. Typical resting tremor disappears with the onset of movement and may become postural later in the course of the disease. Dopaminergic drug therapy usually improves the tremor. In addition to the different forms of tremor, PD also has neurological signs such as muscle stiffness and reduced movement. Physiological tremor normally occurs only when a certain posture is maintained and can be aggravated and become a symptom in certain situations and with the use of specific medications, such as anxiety, stress, fear, exercise, hypoglycemia, thyrotoxicosis, alcohol withdrawal and certain medications, with a frequency of 6 to 12 Hz in the hand, usually with corresponding psychological or medical history features, and the symptoms disappear when the trigger is removed. In addition, the disease needs to be differentiated from tremor caused by other diseases such as cerebellar lesions, demyelinating diseases, and multiple sclerosis, which are not difficult to identify in combination with the corresponding disease characteristics. How to treat idiopathic tremor? If the symptoms are mild and do not affect work and life, clinical observation is possible and no treatment is needed; if the symptoms are more obvious and affect work, treatment can be given by taking insulin; if the symptoms affect work and life, a brain pacemaker is the first treatment method. The surgical method of brain pacemaker for idiopathic tremor is almost the same as that for Parkinson’s disease. In the past, the thalamus was also treated by destruction of the ventral lateral nucleus of the thalamus, but there were more side effects and complications, and usually only one side was used; due to the invention of the pacemaker, it is now rarely used. How effective are pacemakers in treating idiopathic tremor? In fact, brain pacemakers have been used in the treatment of idiopathic tremor for quite a long time, and a large number of successful cases have been reported at home and abroad, and they are considered the most ideal treatment for idiopathic tremor. We have also found that the effect of brain pacemaker treatment for idiopathic tremor is satisfactory, with no significant surgical complications or side effects.