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What You Can Do About Essential Tremor

Chances are you’ve seen someone with a rhythmic shaking of the hands, arms or head. Sometimes the shaking affects a person’s voice. This neurological disorder is called essential tremor. “As many as 10 million Americans are plagued by this chronic movement disorder,” says neurosurgeon Daniel Gaudin, MD, PhD.

The tremor shows up when you’re doing activities liking holding up a newspaper, eating, drinking, or writing. It tends to get worse if you are stressed or fatigued. “It definitely affects quality of life,” Dr. Gaudin explains. “It’s progressive, so at first the tremor is barely noticeable. Eventually you can't drink a cup of coffee without it spilling and burning yourself, or you can't guide your spoon easily to eat, or you can’t write your name legibly.”

Essential tremor is thought to be caused by abnormal signals being sent from various parts of your brain to your muscles, but doctors don’t know exactly what causes the neurochemical disturbance.

The condition can develop in anyone, but in many cases, the disorder runs in families. If one of your parents has it, you have a 50 percent chance of inheriting it. Essential tremor most commonly affects people age 40 and above.

Diagnosing Essential Tremor

Essential tremor often can be confused with other conditions, so getting the right diagnosis is important. If you develop a tremor, your doctor will first want to rule out other causes of tremor such as:

• Thyroid abnormalities
• Electrolyte abnormalities
• Parkinson’s disease
• Dystonia (a movement disorder with involuntary muscle contractions)
• A reaction to medications you may be taking

Doctors diagnose essential tremor by doing a complete neurological and physical exam. They may order a brain MRI and blood tests for further information.

The condition is often confused with Parkinson’s, “but it’s a completely different disease,” says Dr. Gaudin. “It’s possible to have both Parkinson’s and essential tremor, but they are completely different.” The differences include:

• Essential tremor occurs when you’re performing different actions or holding particular postures, whereas Parkinson’s movements generally occur while your hands are at rest.
• People with essential tremor perform tasks at a normal rate, and people with Parkinson’s usually move slowly.
• Essential tremor generally doesn’t cause stiffness, trouble walking, or trouble with balance, but Parkinson’s does.

Treatment Options

There isn’t a single, definitive treatment for essential tremor. Doctors aim for the least invasive treatment that offers the best result for relieving embarrassment and self-consciousness and allows you to function most normally in your daily life. Many patients refuse treatment at first because the tremors aren’t significantly affecting their quality of life, says Dr. Gaudin. “But as the tremors get worse, they may find they’re not comfortable going to restaurants or socializing. Then they turn to treatment.”

Non-medical approaches to treating essential tremor include weighting the arms with wrist weights, and using weighted utensils or a weighted pen to reduce the tremor and improve function. Relaxation techniques and biofeedback can help if your tremors are worsened by anxiety. Avoiding certain medicines and caffeine also may help.

Medication

Essential tremor is initially treated with medications, “yet between 30 and 50 percent of cases don’t respond adequately to medication,” Dr. Gaudin explains. Propranolol and primidone are the medications recommended by the American Academy of Neurology for treatment of essential tremor. Antiseizure medicines, tranquilizers, and Botox injections are other options.

Incision-Free Brain Surgery

The newest treatment option for essential tremor and tremor-dominant Parkinson’s is called incision-free brain surgery (IFBS) (also called MR-guided focused ultrasound). Premier Health is the only health system in southwest Ohio to offer IFBS.

Benefits include:

• Immediate results in reducing or eliminating tremors
• Requires no incisions or exposure to radiation
• You’re awake during the entire procedure
• Recovery is quick (usually no hospital stay is needed)
• Side effects are minimal
• No incision means no risk of infection

Currently IFBS can provide results on one, but not both, sides of your body. It uses ultrasound, a form of energy that passes through your skull without the need for incisions, to destroy targeted tissue that, in turn, controls tremors.

Deep Brain Stimulation (DBS)

DBS has been successfully used for more than 20 years to control tremors. It has shown to be effective in 80 to 90 percent of those who undergo this minimally invasive surgical procedure.

The procedure involves placing a neurostimulator under the skin of your chest and implanting electrodes in your brain. The neurostimulator sends electrical impulses to your brain, which reduces tremors and stiffness.

Deep brain stimulation has shown to be highly effective, says Dr. Gaudin. Unlike incision-free brain surgery, DBS can control tremors on both sides of your body.

Source: Daniel Gaudin, MD, PhD, Clinical Neurosciences Institute, Premier Health; Johns Hopkins Medicine