Essential tremor is a progressive disorder involving the brain and nerves that is characterized by uncontrolled, rhythmic trembling of the various body parts. It may involve the hands, head, voice, legs, or trunk. The intensity of the trembling can vary from mild to very significant.
Essential tremor is a life-altering condition that affects everyday living of a person. Tremors increase during movements such as drinking, eating, dressing, or writing, causing frustration and embarrassment. The tremors may disappear at rest.
Essential tremor is distinct from Parkinson's disease that causes resting tremor. Essential tremor is also called benign, familial, or idiopathic tremor. It is the most common trembling disorder affecting people older than 65 years and affects about 5% of people over the age of 50 years.
What are the signs and symptoms of essential tremor?
The main symptoms associated with essential tremor include:
- Uncontrollable rhythmic shaking that occurs for brief period
- Tremors that worsen with movements
- Difficulty in holding or using small objects
- Shaky voice (if essential tremor affects the voice box)
- A nodding head; involves a “yes-yes” or “no-no” motion of the head
- Tremors that worsen during periods of emotional stress, fatigue, temperature extremes, or certain medicines
- Tremors that lessen with rest
- Problems with balancing in rare cases
What are the complications of essential tremors?
Essential tremor is not life-threatening, but uncontrollable shaking can reduce a person’s quality of life in the following ways by causing
What causes essential tremor?
Although the actual cause of essential tremor is unknown, research suggests the following probable reasons:
- Cerebellum, a part of the hindbrain that controls muscle movements and balance, does not work correctly
- Unusual electrical brain activity in the thalamus (midbrain)
- Inherited genes (a person has about a 50% chance of inheriting the disorder from a parent)
Factors that worsen essential tremor:
The intensity of essential tremor increases due to many factors including:
How is essential tremor diagnosed?
Although there are no specific medical tests to diagnose essential tremor, a doctor diagnoses essential tremor by evaluating several tests:
- Physical examination
- Personal and medical history of the patient
- Electromyography (EMG) test (to check the electrical activity of the muscles)
- Tests to rule out other causes (X-rays, magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan)
- Neurological examination (to evaluate nervous system functioning)
- Laboratory tests (blood and urine tests to rule out heavy metal poisoning)
- Performance tests (to evaluate the intensity of tremor)
- Dopamine transporter scan (to differentiate essential tremor from Parkinson's disease)
How is essential tremor treated?
Medications: Most commonly used drugs to relieve symptoms include:
- Beta-blockers: Propranolol, a beta-blocker that is primarily used to treat high blood pressure, reduces essential tremor symptoms. Beta-blockers may not be an option if a patient has asthma or certain heart problems. Side effects include fatigue, light headedness, or heart problems.
- Anti-seizure medications: Primidone, gabapentin, and topiramate may be effective in people who don't respond to beta-blockers. Side effects include drowsiness and nausea, which usually disappear within a short time.
- Anti-anxiety medications: Clonazepam, diazepam, lorazepam, and alprazolam may be used to treat people in whom tension or anxiety worsens the tremors. Side effects can include fatigue or mild sedation.
- Botulinum toxin injections: These are useful in treating head and voice tremors. However, using Botox to treat hand tremors causes weakness in the fingers.
Surgery: Surgery may be an option if tremors are severely disabling and don't respond to medications.
- Chronic thalamic deep brain stimulation (DBS): This includes implanting a stimulating device in the thalamus.
- MR-guided focused ultrasound: This noninvasive surgery involves using focused sound waves that generate heat to destroy the brain tissue in the thalamus.
- Stereotactic thalamotomy: It causes permanent changes in brain activity.
Therapy: Physical or occupational therapy relieve symptoms:
- Physical therapy involves exercises to improve muscle strength, control, and coordination.
- Occupational therapy helps the patient adapt to living with essential tremor.
Adaptive devices: These are external devices that can help change or control the severity of tremors. The devices include neuromodulation devices and tremor cancellation devices that control hand tremors.
Lifestyle changes and home remedies: Lifestyle changes that need to be made to reduce and relieve essential tremors include:
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