Description

Essential tremor is a nervous system disease, also known as a neurological condition. Cause rhythmic movement that you can't control. Essential tremor can affect almost any part of the body, but the trembling occurs most often in the hands. The tremor occurs especially when doing simple tasks, such as drinking from a glass or tying shoelaces.

Essential tremor is usually not a dangerous condition. However, it usually gets worse over time and can be severe for some people. Other conditions don't cause essential tremor, but the essential tremor, sometimes confused with Parkinson's disease.

Essential tremor can occur at any age but is more common in people of 40 years of age and older.

Symptoms

Essential tremor symptoms:

  • Start slowly. They are generally more noticeable on one side of the body.
  • They get worse with movement.
  • Usually occur in the hands first, involving a hand or both hands.
  • You can include a "yes-yes" or "no-no" double-nodding or shaking motion of the head.
  • It can get worse with emotional stress, fatigue, caffeine, or extreme temperatures.

Essential tremor vs. Parkinson's disease

Many people associate the tremors of Parkinson's disease. But the two conditions differ in important aspects, including:

  • Time tremors. The essential tremor of the hands usually occurs when the use of the hands. The tremors of Parkinson's disease are more noticeable when the hands are resting on the sides of the body or in the lap.
  • - Related conditions. Essential tremor does not cause other health problems. However, people with essential tremor, sometimes, you develop other neurological symptoms, such as an unsteady walk. Parkinson's disease is linked to the stooped posture, slow movement and dragging your feet when you walk.
  • Parts of the body are affected. Essential tremor is primarily in the hands, head and voice. Parkinson's disease tremors usually begin in the hands and can affect the legs, chin and other body parts.

Causes

Approximately half of people with essential tremor appear to have an altered gene. This form of the disease known as familial tremor. It is not clear what causes essential tremor in people who do not have a familial tremor.

Risk factors

The known risk factors for essential tremor include:

  • Altered gene.The inherited variety of essential tremor, known as familial tremor, is an autosomal dominant disorder. That means that a gene is altered in only one of the parents is necessary to pass from the condition. Any person who has a parent with an altered gene for essential tremor have a 50% chance of developing the disease.
  • Age. Essential tremor is more common in people of 40 years of age and older.

Altered gene. The inherited variety of essential tremor, known as familial tremor, is an autosomal dominant disorder. That means that a gene is altered in only one of the parents is necessary to pass from the condition.

Any person who has a parent with an altered gene for essential tremor have a 50% chance of developing the disease.

Complications

Essential tremor is not life-threatening, but the symptoms often get worse with time. If the tremors become severe, can be difficult:

  • Hold a cup or glass without spilling.
  • Eat without agitation.
  • Put on makeup or shaving.
  • Speak, if the case of the voice or of the tongue is affected.
  • Write legibly.

Prevention

There is no known way to prevent essential tremor.

Diagnosis

The diagnosis of essential tremor involves reviewing your medical history, family history and symptoms and perform a physical exam.

There are No medical tests to diagnose essential tremor. The diagnosis is often a matter of ruling out other conditions that could be causing the symptoms. To do this, the health care provider may suggest the following tests.

Neurological examination

In a neurological exam, your health care professional tests how well your nervous system is working. This may include verification of:

  • The tendon reflexes.
  • The muscle strength and tone.
  • The ability to feel certain sensations.
  • The posture, and coordination.
  • Walking and balance.

Laboratory tests

Blood and urine may both be tested by a number of factors, including:

  • Disease of the thyroid.
  • Metabolic problems.
  • Medicine side effects.
  • The levels of chemicals that can cause tremor.

Performance testing

To evaluate the tremor itself, your health care professional may ask you to:

  • Drinking from a glass.
  • Keep your arms extended.
  • Write.
  • Draw a spiral.

A health care professional who is not yet sure if the tremor is essential tremor or Parkinson's disease can order a dopamine transporter scan. This is a special imaging test that uses a drug injected to show where the chemical dopamine is found in the brain. You can help the health professional to tell the difference between the two types of tremors.

Treatment

Some people with essential tremor do not require treatment if your symptoms are mild. But if the essential tremor is to make it difficult to work or perform daily activities, discuss treatment options with your health care professional.

Treatment options may include:

Medications

  • Beta-blockers. Normally it is used to treat high blood pressure, beta-blockers, such as propranolol (Inderal LA, InnoPran XL, Hemangeol) help relieve tremors in some people. Beta-blockers may not be an option for people with asthma or certain heart problems. Side effects may include fatigue, dizziness, or heart problems.
  • Anti-epileptic drugs. Primidone (Mysoline) may be effective in people who do not respond to beta-blockers. Other medications that may be prescribed include gabapentin (Gralise, Neurontin, Horizant) and topiramate (Topamax, Qudexy XR, others). Side effects include drowsiness and nausea, which usually disappear within a short period of time.
  • Tranquilizers. Health professionals can use benzodiazepines such as clonazepam (Klonopin) to treat people whose tremors worsen with stress or anxiety. Side effects might include fatigue or mild sedation. These medicines should be used with caution, as it may be habit forming.
  • Nerve-blocking injections.Injections with onabotulinumtoxinA, also known as Botox, may be useful in the treatment of certain types of tremors, especially of the head and voice tremors. Botox injections can improve tremor for up to three months at a time. However, if the Botox is used to treat tremors in the hands can cause weakness in the fingers of the hands. If Botox is used to treat tremors of voice, it can cause a hoarse voice and difficulty swallowing.

Nerve-blocking injections. Injections with onabotulinumtoxinA, also known as Botox, may be useful in the treatment of certain types of tremors, especially of the head and voice tremors. Botox injections can improve tremor for up to three months at a time.

However, if the Botox is used to treat tremors in the hands can cause weakness in the fingers of the hands. If Botox is used to treat tremors of voice, it can cause a hoarse voice and difficulty swallowing.

Therapy

Health professionals may suggest physical or occupational therapy. Physical therapists can teach you exercises to improve muscle strength, control and coordination.

Occupational therapists can help to adjust to life with essential tremor. Therapists may suggest adaptive devices to reduce the effect of the tremors in their daily activities. These devices may include:

  • More heavy glasses and kitchen utensils.
  • The weight of the wrist.
  • Larger, heavier tools for writing, such as the large grip pens.

The nerve stimulation devices

A portable electronic peripheral nerve stimulation device (Cala Trio, Cala kIQ) is a new treatment option for people with essential tremor. The device is worn as a bracelet to 40 minutes twice a day. It works by stimulating nerves and muscles to create a muscle response that reduces the tremor. Studies have found that the device can bring some improvement to the tremors.

Surgery

Surgery may be an option if the tremors are severely disabling and do not respond to medication.

  • The deep brain stimulation.This is the most common type of surgery for essential tremor. It involves placing a long, slim power of the probe on the part of the brain that causes tremors, known as the thalamus. A probe cable runs under the skin to a device called a neurostimulator that is placed under the skin in the chest. This device sends electrical impulses painless to interrupt signals from the thalamus that may be the cause of the tremors. Side effects of deep brain stimulation may include a malfunction of the computer and the problems with the motor control of speech, or of the balance. The headaches, and weakness can also be side effects. After some time or setting of the device, sometimes the side effects go away.
  • Focused ultrasound thalamotomy.This non-invasive surgery involves the use of concentrated sound waves that travel through the skin and skull. The waves generate heat to destroy the brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to guide the correct area of the brain, and to make sure that the sound waves are the generation of the exact amount of heat necessary for the procedure. Focused ultrasound thalamotomy is done on one side of the brain. The operation affects the other side of the body where it is made. Focused ultrasound thalamotomy creates a lesion that can result in permanent changes in brain function. Some people have experienced altered sensation, difficulty walking, or difficulty in movement. However, most of these complications disappear or are mild enough that they do not interfere with the quality of life.

The deep brain stimulation. This is the most common type of surgery for essential tremor. It involves placing a long, slim power of the probe on the part of the brain that causes tremors, known as the thalamus. A probe cable runs under the skin to a device called a neurostimulator that is placed under the skin in the chest. This device sends electrical impulses painless to interrupt signals from the thalamus that may be the cause of the tremors.

Side effects of deep brain stimulation may include a malfunction of the computer and the problems with the motor control of speech, or of the balance. The headaches, and weakness can also be side effects. After some time or setting of the device, sometimes the side effects go away.

Focused ultrasound thalamotomy. This non-invasive surgery involves the use of concentrated sound waves that travel through the skin and skull. The waves generate heat to destroy the brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to guide the correct area of the brain, and to make sure that the sound waves are the generation of the exact amount of heat necessary for the procedure.

Focused ultrasound thalamotomy is done on one side of the brain. The operation affects the other side of the body where it is made.

Focused ultrasound thalamotomy creates a lesion that can result in permanent changes in brain function. Some people have experienced altered sensation, difficulty walking, or difficulty in movement. However, most of these complications disappear or are mild enough that they do not interfere with the quality of life.

Lifestyle and home remedies

To reduce or relieve tremors:

  • Avoid caffeine. Caffeine and other stimulants can increase tremors.
  • The use of alcohol in moderation, if at all. Some people notice that their tremors improve slightly after they drink alcohol, but drinking is not a good solution. Tremors tend to get worse once the effects of the alcohol wear off. Also, more alcohol, finally, it is necessary to relieve the tremors, which can lead to alcohol use disorder.
  • Learn to relax. Stress and anxiety tend to make the tremor worse. Being relaxed can improve the tremors. You can't remove from your life all of the stress. But you can change the way you react to stressful situations, using a wide range of relaxation techniques, such as massage or meditation.
  • Make lifestyle changes. The use of the hand that is less affected by the tremor more often. Finding ways to avoid writing such as the use of online banking and debit cards instead of writing checks. Try voice commands in the smart phone and the voice recognition software in your computer.

Coping and support

For many people, essential tremor, it can have serious social consequences, and psychological. If the effects of essential tremor make it difficult to live life as fully as you once did, consider joining a support group.

Support groups are not for everyone, but you may find it helpful to have the breath of the people who understands what is going on. Or see a counselor or social worker who can help you meet the challenges of living with essential tremor.

Preparing for your appointment

It is likely to start by seeing your primary healthcare professional. Or you may be referred to a doctor trained in brain and nervous system conditions, call a neurologist.

Here's some information to help you prepare for your appointment.

What you can do

  • Be conscious of any thing you need to do ahead of time. At the time of making the appointment, ask if there is something that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you have, including those that do not seem to be related to the reason for which you scheduled the appointment.
  • Write important personal information, including major stresses or recent life changes.
  • Make a list of all the medicines, vitamins, and supplements you are taking and the dose.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Write questions to ask their health care team.

Your time with your health care team is limited, so preparing a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. For essential tremor, some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • What tests do I need?
  • How does essential tremor usually progress?
  • What treatments are available, and which do you recommend?
  • I have other health conditions. How can I best manage these conditions?
  • There are restrictions that must be followed?
  • You should see a specialist? If so, who do you recommend?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

  • When did your symptoms begin?
  • Do you have a family history of tremor?
  • Have you ever had a head injury?
  • What parts of the body are affected?
  • Is there something that the tremors better or worse?
Symptoms and treatment of Essential tremor