Essential tremor guide
What is essential tremor?
Essential tremor - is a neurological (nervous system) disease characterized by forced shaking of particular body parts, usually the head and hands. A tremor is an unintentional, rhythmic movement of a body part.
Essential tremor is most common in people over 65, but it can affect people at any age. The disease is quite common, affecting about 1% of people worldwide.
The pathology is not life-threatening and does not cause significant health problems, although shaking can make usual activities such as eating and drinking difficult. Doctors don't understand the actual cause of essential tremor, but it's believed to be caused by unusual electrical activity in the brain and the thalamus.
Diagnostic tests
The tremor can vary from mild to severe. The trembling may be so slight that it does not affect daily life or may be powerful enough to interfere with everyday activities. The symptoms of essential tremor in various parts of the body are as follows:
- Noticeable trembling in the hands or forearms when trying to perform hand actions;
- Head and neck tremors result in rhythmic up and down or side to side movements of the head;
- Twitching of parts of the face, such as the eyelids;
- Tremor of the tongue or larynx makes the voice tremble;
- Tremors in the trunk, legs, and feet can cause balance problems and affect gait.
There are no specific tests to help diagnose essential tremor. Instead, a doctor may do a neurological exam and other tests to evaluate the tremor and rule out other causes. Essential tremor is diagnosed with several tests, including:
- Medical history - the doctor will evaluate the personal account of the patient's illness and the history of the health of the patient's entire family, as heredity can be traced.
- Neurological examination - the doctor will observe external manifestations of tremor, gait, state of rest, and facial movement.
- Blood and urine tests - can help determine the patient's general health and rule out other conditions.
- Brain MRI scan - is a painless, non-invasive examination that provides clear images of the brain and its stem. The test helps rule out other conditions, such as a stroke, a brain tumour, or unusual brain structures.
- Electromyography (EMG) or electroencephalography (EEG) measures the amount of electrical activity in the muscles.
- Genetic testing - is the study of the DNA sequence or structure of a person's chromosomes to detect the corresponding changes.
As part of the examination, the doctor might look for other causes of the tremor, such as thyroid disease or medication side effects.
Treatment methods
If the essential tremor is mild, it may not need treatment. A medical or rehabilitative approach may be recommended if the disease affects the quality of life or the ability to perform daily tasks.
- Botulinum toxin injections (Botox) - can help treat certain types of tremors, especially tremors of the head and voice. Botox injections can reduce tremors for up to three months.
- Beta-blockers - used to treat high blood pressure, such as propranolol (Inderal, InnoPran XL, Hemangeol) help relieve tremors in some people.
- Anticonvulsants - Epilepsy drugs such as primidone (Mizolin) may be effective in people who do not respond to beta-blockers. Other drugs that might be prescribed include gabapentin (Gralise, Neurontin, Horizant) and topiramate (Topamax, Qudexy XR, others).
- Tranquilizers - benzodiazepine drugs such as clonazepam (Klonopin) are used to treat people in whom tension or anxiety makes the tremor worse.
The following non-drug adaptive devices and rehabilitation methods are very effective:
- Adaptive devices - are external devices that can help change or control the amount of shaking.
- Physiotherapy - procedures and exercises that help increase muscle strength, reduce muscle stiffness and spasms, reduce the risk of falls, etc.
- Occupational therapy - hand therapy using an exercise program and functional activities alone or in groups.
- Speech and language therapy - is the education of family members and assistance in written communication.
- Relaxation and stress management - includes techniques such as meditation, relaxation training, tai chi, yoga etc. Some patients find these methods helpful.
New treatment options
Awareness of other new developments in treating essential tremors is crucial. New surgical methods of treatment:
- Deep brain stimulation (DBS) - is a surgical procedure used to treat various neurological disorders. Battery-powered stimulator - implanted in the body and provides electrical stimulation to the areas of the brain responsible for tremor symptoms. The stimulator is placed in the chest, and extension wires connect the stimulator to wires (electrodes) deep in the brain. The device is controlled by remote control.
- MRI-guided focused ultrasound ablation - combines two technologies: MRI allows for better vision and planning, and ultrasound is a form of energy that passes through tissues. Ultrasonic beams are concentrated and focused on a specific target, increasing the temperature, which destroys the target tissue.
- Radiosurgical (Gamma Knife) thalamotomy - is a radiological machine that delivers precisely focused beams to a predetermined point deep in the brain. When the beams are concentrated at one point, a strong dose of radiation is provided, and the target area responsible for the abnormal movements is destroyed. Destroying a target interrupts the brain's signal, telling the muscles to move.
Since the exact cause of essential tremor is unknown, it cannot be prevented. But knowing that essential tremor has a genetic link gives researchers clues as they look for treatments and prevention.
Statistics and prognosis
Patients with essential tremor regularly inquire about their prognosis. Thus, physicians must review the available medical literature for meaningful answers. In addition, given the progressive nature of the disease, it can be assumed that many patients will experience an increase in the severity of symptoms over time.
The US National Institutes of Health assessed the progression and change in symptoms of essential tremor based on years of observation and personal assessment of patients. The results were processed every six months. 26.8% of patients reported worsening their condition every six months, and 63.4% of the deterioration occurred in half or more.
When patients reported worsening symptoms, their responses were categorized as follows: increased tremor - 34%; difficulties in performing actions - 33.1%; drugs do not affect the symptoms of tremor - 6%; difficulty in controlling tremor - 3.3%; other challenges caused by tremor - 17.7%.
Many people with essential tremor live everyday lives. For example, the famous actress Katharine Hepburn has had a successful career despite the essential tremor that has affected her head and voice. But in no case should this progressive disease be neglected since life with it is extremely difficult.
AiroMedical specialists care for many patients and are well versed in many manifestations of this pathology. We also offer treatments that alleviate symptoms and improve patients' quality of life.
References:
- Healthline: Essential tremor
- National Organization for Rare Disorders: Essential Tremor
- Victoria State Government: Essential tremor
- Healthline Media UK: What to know about essential tremor
- The President and Fellows of Harvard College: Essential tremor and how to manage it
- IETF: RADIOSURGICAL (GAMMA KNIFE®) THALAMOTOMY
- Frontiers Media S.A.: Worse and Worse and Worse: Essential Tremor Patients’ Longitudinal Perspectives on Their Condition
