Diann Shaddox Foundation for Essential Tremor
Essential tremor (ET) is when you have uncontrolled shaking movements in parts of your body - most commonly the arms and hands. It tends to occur in families. It is mild in some people but can become severe, debilitating, and demoralizing. First and foremost, Essential Tremor can begin at any age from ages 1 to 100. ET doesn’t discriminate with age, race, sex, or national origin.
What is Essential Tremor? ET is a progressive neurological condition that causes a rhythmic trembling of the hands, head, voice, legs, or trunk. Over 10 million Americans, including children, have Essential Tremor. That’s about 5% of all people in the United States. Most people though haven’t heard about Essential Tremor and we have to educate schools, first responders, and even medical personal.
Essential tremor usually starts in one hand or one of your arms. Within 1-2 years, the other hand/arm is likely to be affected and it may spread to involve the legs, head, and voice. It can sometimes become quite severe so that everyday activities such as holding a cup can become difficult. ET isn’t only a social problem it can interfere with all aspects of your life like walking and speech can become difficult when your voice quivers so you have trouble talking. Loss of your abilities is hard to have a purpose in life. The tremor is usually not there at rest but becomes noticeable when the affected body part is held in a position, or with movement. The tremor can be present at all times and may be worse with stress, tiredness, hunger or certain emotions such as anger. Extremes in temperature may also make the tremor more severe.
What causes essential tremor?
Essential tremor is known to run in families. At least 5-7 out of 10 people with essential tremor have other members of the family with the same condition.
Up to 7 in 10 people with essential tremor find that the tremor reduces after drinking some alcohol.
How is essential tremor diagnosed? There is no test to diagnose essential tremor. Your doctor can usually diagnose essential tremor based on your explanation of the tremor and an examination. It is important for the doctor to make sure that there are no other conditions present that are causing tremor. In some cases, this may mean that you need to have some tests to rule out other conditions. For example, blood tests or a brain scan. You may also be referred to a neurologist (a doctor with a special interest and expertise in the brain and nerves).
While the diagnosis of ET remains a visual one, certain brain scans Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) may be helpful in eliminating any other conditions which also produce tremor as a symptom. For example growths such as tumors or damage to the brain can be seen on certain brain scans. Blood samples may also be taken to rule out thyroid or copper metabolism problems, both of which can cause tremor. DATScan a diagnostic test can distinguish between ET and tremors of Parkinson's disease.
Other conditions that can cause tremor and need to be ruled out include a side effect from some prescribed medicines, anxiety, caffeine, some poisons, kidney, liver disease, thyroid disease, Parkinson's disease and other movement disorders.
What is the treatment for essential tremor? Essential tremor cannot be cured. Treatment may reduce the severity of the tremor. There are various treatments that are used.
Medication There are two medicines used initially for essential tremor - propranolol and primidone. These medicines have been shown to ease the tremor in up to 8 in 10 affected people.
Propranolol - this is a medicine that is usually used in heart disease. It is in a class of medicines called beta-blockers. It has also been shown to be effective in essential tremor. This medicine should be used with care if you have a heart conduction problem or a lung disease such as asthma. The most common side effects with propranolol are dizziness, tiredness, and nausea (feeling sick).
Primidone (Mysoline), - this is a medicine that is primarily used for epilepsy, but it also works very well in essential tremor. The most common side-effects are sleepiness, dizziness and nausea. These may improve if you continue to take this medicine.
OnabotulinumtoxinA (Botox) injections. Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.
However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If it's used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.
When the diagnosis of essential tremor is made, you may be offered one of these medicines. A low dose is usually started at first, and gradually increased until your tremor is eased. If you reach the maximum dose without a satisfactory improvement, then the other medicine can be tried. If that also doesn't work, you can try them together. Other medicines can be tried if these two are not effective. A wide range of medicines have been shown to have some effect on reducing the severity of the tremor.
Surgery If medicine treatment is not effective, and the tremor is severe, then a surgical procedure may be an option. There are two main surgical procedures that may be considered - thalamotomy and thalamic deep brain stimulation. They both involve the thalamus. This is a deep part of the brain that organizes messages travelling between the body and brain. High intensity focused ultrasound waves precisely target a focal point in the Vim nucleus of the thalamus can also be used.
What is Exablate Neuro?
High intensity focused ultrasound waves precisely target a focal point in the Vim nucleus of the thalamus, the tiny part of the brain that is thought to be responsible for causing tremors. The Exablate Neuro ultrasound transducer consists of 1024 beams that generate enough heat to ablate the targeted tissue during treatment. The result is an immediate and significant reduction of tremor for patients.
During planning and treatment for essential tremor, the patient is fully conscious and lying on the treatment bed in an MRI scanner. MRI provides high resolution visualization, patient-specific treatment planning and continuous monitoring of the procedure. Real-time thermal feedback allows the physician to control and adjust the treatment, ensuring that the targeted tissue is completely ablated without impacting adjacent healthy tissue.
This revolutionary, non-invasive treatment offers a life changing treatment to patients with essential tremor.
Difference in focused ultrasound:
MINIMAL HOSPITALIZATION and short recovery time
SHARP, ACCURATE Lesions as small as 2mm, no penetrating trajectories, no implanted hardware, no ionizing radiation, less risk of infection.
REAL TIME MRI guidance for targeting and thermal feedback, with immediate results
Thalamotomy -in this procedure, the thalamus on one side of the brain is destroyed. It has been shown to be very effective. It stops or greatly reduces the tremor in up to 9 out of 10 people with essential tremor. There are risks involved such as a bleed into the brain. Potential side-effects include muscle weakness, speech problems and memory loss. If the thalamus on both sides of the brain is destroyed, there is a higher chance of side effects. This is not usually recommended.
Thalamic deep brain stimulation- this procedure involves placing an electrode (fine wire) into the thalamus on one or both sides of the brain. The electrode is connected to a device called a stimulator. The electrode and stimulator stay in the body. (The stimulator is placed under the skin at the top of the chest.) The simulator sends electrical impulses down the electrode to the thalamus. It is not known exactly why this device works. It seems to interrupt or block the nerve signals coming through the thalamus that cause the tremor. If you have this procedure, you will need to have regular reviews to make sure that the stimulator setting is correct. This aims to minimize side-effects and maximize benefit. It may produce a good response in up to 9 out of 10 affected people. Again, there is a small risk that the procedure may cause a bleed into the brain. Side effects include loss of sensation, speech problems, and weakness. These usually resolve when the stimulator settings are adjusted.
Botulinum toxin injections. There is some evidence that Botox injections are helpful in reducing certain tremors. Unfortunately, a Botox injection into the arm also produces weakness of the arm. This is usually not tolerated. It is mainly useful when essential tremor affects the head and neck.
Alcohol - Many people find that alcohol is helpful in reducing their tremor. It needs to be used with caution to avoid developing an alcohol problem. It is not advisable to drink more than the normal recommended amount of alcohol. That is: men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week. Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week. Pregnant women, and women trying to become pregnant, should not drink alcohol at all. One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.
Avoid caffeine. Caffeine and other stimulants can increase tremors
Stress and anxiety Stress and anxiety tend to make tremors worse, and being relaxed may improve tremors.
What is the outlook? Essential tremor is a progressive disease. This means that it tends to gets worse over time. There needs to be more research on the cause to find more medicines that work for ET and to find a cure.
What is it like to live with Essential Tremor?
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