Essential Tremor and Children
Recent research indicates that 5 out of every 100 children under the age of 20 has Essential Tremor. That number is staggering, and represents a significant increase in the incidence of ET in children from even ten years ago.
Essential Tremor in Children
Essential tremor (ET) is often thought of as an adult onset condition.
However, it can start any age and in early childhood affecting about 5% of children, predominantly involving the hands. There are two kinds of hand tremor, which are: Kinetic tremor only (i.e. tremor present only when the hands are moving) and Postural tremor only (i.e. tremor is visible when the hands are held outstretched) with some children experiencing both. The hand tremor leads to difficulty holding drinks, eating, writing, coloring, playing a musical instrument and sports.
Very little is known about the treatment of ET in childhood but it is helpful to be open about the condition, to discuss it and to have a common sense open approach. Children will often cope better than adults until school age when often a variety of problems such as writing, school meal times and comments from peers, may cause anxiety and embarrassment.
Recent research indicates that 5 out of every 100 children under the age of 20 has Essential Tremor. That number is staggering, and represents a significant increase in the incidence of ET in children from even ten years ago.
ET inevitably affects the hands in childhood but head tremor is relatively rare, being apparent in about 5% of children that have ET.
Essential tremor (ET) is often thought of as an adult onset condition.
However, it can start any age and in early childhood affecting about 5% of children, predominantly involving the hands. There are two kinds of hand tremor, which are: Kinetic tremor only (i.e. tremor present only when the hands are moving) and Postural tremor only (i.e. tremor is visible when the hands are held outstretched) with some children experiencing both. The hand tremor leads to difficulty holding drinks, eating, writing, coloring, playing a musical instrument and sports.
Very little is known about the treatment of ET in childhood but it is helpful to be open about the condition, to discuss it and to have a common sense open approach. Children will often cope better than adults until school age when often a variety of problems such as writing, school meal times and comments from peers, may cause anxiety and embarrassment.
Recent research indicates that 5 out of every 100 children under the age of 20 has Essential Tremor. That number is staggering, and represents a significant increase in the incidence of ET in children from even ten years ago.
ET inevitably affects the hands in childhood but head tremor is relatively rare, being apparent in about 5% of children that have ET.
|
|
Where to start if you have a child with tremors.
First things first, be sure that your child has been diagnosed by a movement disorder neurologist. Many pediatricians and some general neurologists may not be familiar with the diagnosis of movement disorders in children. They may not know the other testing that needs to be done to be sure it is ET and not something else or that it is ET alone, as many children with ET have more than one disorder. If you need help finding a movement disorder neurologist, the best approach is to contact your local teaching hospital in your area and ask for an appointment with a pediatric movement disorder neurologist.
What should you expect from your child’s doctor visit? First, the doctor will want to gather as much information about your child’s tremor as possible. They will ask when you first noticed the tremor, and when it happens most now. Is it when your child is eating or coloring or writing? Is it there all the time? What exactly is shaking? Fingers, arms, legs, head? What makes the tremor better or worse? What other problems (if any) have you noticed? Arm or leg stiffness, jerky movements of the head, arms, or legs, and swelling of the legs can all indicate that there may be a condition other than ET, or in addition to ET, that is affecting your child.
Next, the doctor will do a physical exam. Most of the time the doctor will do a full exam, listening to your child’s heart and lungs, and checking the child’s belly. They will look at your child’s eyes, their smile, look at how they walk or crawl, and check to see how “strong” their muscles are. The type of exam to evaluate tremor will depend on the age of your child. For babies, most of the exam involves checking for normal infant reflexes, then presenting an object to the baby just out of reach to check for postural tremor, and then giving the baby something to play with to see they if shake when they try to bring it to their mouth (action tremor). Young children will be given crayons to draw with or blocks to build with and observed for different types of tremor during this “playtime”. Children over five will have an exam very similar to an adult evaluation for tremor, including being asked to draw a spiral, write their name, pour water from one cup to another, and drink from a cup.
After this exam, the doctor will likely schedule some tests, including blood tests to check your child’s blood sugar, thyroid levels, liver function, and other tests. They may order an X-ray called an MRI of the brain. MRIs are safe in children. Some children may need to be sedated to lay still for the test or may need a type of scan that requires “contrast” dye to be injected before the scan. There are some small risks with sedation and contrast that your child’s doctor will talk with you about before scheduling the test. Most doctors will not recommend a CT scan in children under 15 years old as there is a small (less than 1 in 1000) chance that a child can get cancer from high radiation exposure in some CT scans. If your doctor is recommending a CT, be sure to ask about the risk and other ways they could get the information they are seeking.
When all these tests are complete, you will have another visit with your child’s doctor to discuss the results. ET is considered a diagnosis of “exclusion” which means there is no test that will tell you that your child definitely has ET. The purpose of these tests is to make sure there is nothing else causing the tremors that needs a different treatment.
There are some ways you can help your child during the doctor visit and during the testing. First, tell them what to expect. Talk to them about what is in this post so they know what will happen during the visit. Next, if your child is old enough to talk to the doctor themselves, give them a chance to do so before you answer the questions for them. They may be experiencing symptoms that you haven’t seen and that they haven’t told you about. When you answer for them before giving them a chance to answer, the doctor may not get all the information they need. Lastly, when possible, take your child to the place they will get their blood drawn or have their MRI scan before the day of the appointment. This will help them be more at ease. You can also “practice” at home what will happen during these tests to help them be less anxious.
Once you and your child’s doctor are comfortable with the diagnosis, then they can begin to discuss treatment options with you. There are a number of natural treatment options for children with ET as well as medical treatments available.
Dr. Darlene A. Lobel is a board certified neurosurgeon who is internationally known as an expert in the treatment of essential tremor and other movement disorders.
First things first, be sure that your child has been diagnosed by a movement disorder neurologist. Many pediatricians and some general neurologists may not be familiar with the diagnosis of movement disorders in children. They may not know the other testing that needs to be done to be sure it is ET and not something else or that it is ET alone, as many children with ET have more than one disorder. If you need help finding a movement disorder neurologist, the best approach is to contact your local teaching hospital in your area and ask for an appointment with a pediatric movement disorder neurologist.
What should you expect from your child’s doctor visit? First, the doctor will want to gather as much information about your child’s tremor as possible. They will ask when you first noticed the tremor, and when it happens most now. Is it when your child is eating or coloring or writing? Is it there all the time? What exactly is shaking? Fingers, arms, legs, head? What makes the tremor better or worse? What other problems (if any) have you noticed? Arm or leg stiffness, jerky movements of the head, arms, or legs, and swelling of the legs can all indicate that there may be a condition other than ET, or in addition to ET, that is affecting your child.
Next, the doctor will do a physical exam. Most of the time the doctor will do a full exam, listening to your child’s heart and lungs, and checking the child’s belly. They will look at your child’s eyes, their smile, look at how they walk or crawl, and check to see how “strong” their muscles are. The type of exam to evaluate tremor will depend on the age of your child. For babies, most of the exam involves checking for normal infant reflexes, then presenting an object to the baby just out of reach to check for postural tremor, and then giving the baby something to play with to see they if shake when they try to bring it to their mouth (action tremor). Young children will be given crayons to draw with or blocks to build with and observed for different types of tremor during this “playtime”. Children over five will have an exam very similar to an adult evaluation for tremor, including being asked to draw a spiral, write their name, pour water from one cup to another, and drink from a cup.
After this exam, the doctor will likely schedule some tests, including blood tests to check your child’s blood sugar, thyroid levels, liver function, and other tests. They may order an X-ray called an MRI of the brain. MRIs are safe in children. Some children may need to be sedated to lay still for the test or may need a type of scan that requires “contrast” dye to be injected before the scan. There are some small risks with sedation and contrast that your child’s doctor will talk with you about before scheduling the test. Most doctors will not recommend a CT scan in children under 15 years old as there is a small (less than 1 in 1000) chance that a child can get cancer from high radiation exposure in some CT scans. If your doctor is recommending a CT, be sure to ask about the risk and other ways they could get the information they are seeking.
When all these tests are complete, you will have another visit with your child’s doctor to discuss the results. ET is considered a diagnosis of “exclusion” which means there is no test that will tell you that your child definitely has ET. The purpose of these tests is to make sure there is nothing else causing the tremors that needs a different treatment.
There are some ways you can help your child during the doctor visit and during the testing. First, tell them what to expect. Talk to them about what is in this post so they know what will happen during the visit. Next, if your child is old enough to talk to the doctor themselves, give them a chance to do so before you answer the questions for them. They may be experiencing symptoms that you haven’t seen and that they haven’t told you about. When you answer for them before giving them a chance to answer, the doctor may not get all the information they need. Lastly, when possible, take your child to the place they will get their blood drawn or have their MRI scan before the day of the appointment. This will help them be more at ease. You can also “practice” at home what will happen during these tests to help them be less anxious.
Once you and your child’s doctor are comfortable with the diagnosis, then they can begin to discuss treatment options with you. There are a number of natural treatment options for children with ET as well as medical treatments available.
Dr. Darlene A. Lobel is a board certified neurosurgeon who is internationally known as an expert in the treatment of essential tremor and other movement disorders.
Essential Tremor in Childhood
Essential tremor (ET) may occur in children and has a prevalence of 4.6%-5.3% of the childhood population. There is often a family history of tremor. In my study of hereditary essential tremor 25% of people with ET developed tremor in their first decade and 60% in their second decade. No tremor related disability was present before the age of ten. However, 55% of young people with ET had disability and 25% reported social handicap by the age of 20 years old.
ET inevitably affects the hands in childhood but head tremor is relatively rare, being apparent in about 5% of children. The types of hand tremor present are:
1. 20% have kinetic tremor only (i.e. tremor present only when the hands are moving).
2. 5% have postural tremor only (i.e. tremor is visible when the hands are held outstretched).
3. 75% have both postural and kinetic tremor.
The functional impact of ET in children includes difficulty with:
1. Holding a hot drink
2. Drinking from a cup
3. Using a spoon
4. Writing
5. Typing
6. Drawing
8. Painting nails
9. Playing a musical instrument
The frequency (the number of tremor cycles per second, measured in Hz from the fingers) of ET in children is interesting, having a lower frequency in the 7-12 years than the 14-16 years age range (average 5.3Hz compared to 9.0Hz respectively). Curiously putting a 300 gram weight on the fingers of young (7-12 years old) children increases the tremor frequency from 5.3Hz to 8.2Hz, whilst in teenagers and adults it has no effect on tremor frequency. When electromyographic (EMG) recordings of tremor are made from children with ET, the tremor has an alternating pattern between the flexor and extensor muscles of the forearm (i.e. the tremor is caused by bursts activity in the muscles of the finger flexors, then finger extensors, then flexors then extensors and so on).
Tremor in children may be associated with dystonia (sustained muscle spasms) or tics. In addition an over-active thyroid gland may cause tremor and so a blood sample for thyroid function tests may be required.
Very little is known about the treatment of ET in childhood, although small doses of propranolol (20-60mg) have been reported to help small numbers of children. There are no proper randomized placebo controlled studies of any treatment for ET in children.
The psychology of children is a very complex field. However, one way of preparing a child with ET for the almost inevitable school playground comments, is where possible, to be open about the condition.
Conclusion Essential tremor affects about 5% of children. It predominantly involves the hands and may produce disability and handicap by the second decade. When necessary small doses of propranolol may be helpful, although there are no controlled trials to prove that it is effective for ET in children (unlike adults where there is class A evidence to support its use). A common sense open approach about the condition is probably wise.Dr Peter G Bain MA MD FRCP Reader & Consultant in Clinical Neurology Division of Neurosciences, Charing Cross Hospital, Imperial College London
Essential tremor (ET) may occur in children and has a prevalence of 4.6%-5.3% of the childhood population. There is often a family history of tremor. In my study of hereditary essential tremor 25% of people with ET developed tremor in their first decade and 60% in their second decade. No tremor related disability was present before the age of ten. However, 55% of young people with ET had disability and 25% reported social handicap by the age of 20 years old.
ET inevitably affects the hands in childhood but head tremor is relatively rare, being apparent in about 5% of children. The types of hand tremor present are:
1. 20% have kinetic tremor only (i.e. tremor present only when the hands are moving).
2. 5% have postural tremor only (i.e. tremor is visible when the hands are held outstretched).
3. 75% have both postural and kinetic tremor.
The functional impact of ET in children includes difficulty with:
1. Holding a hot drink
2. Drinking from a cup
3. Using a spoon
4. Writing
5. Typing
6. Drawing
8. Painting nails
9. Playing a musical instrument
The frequency (the number of tremor cycles per second, measured in Hz from the fingers) of ET in children is interesting, having a lower frequency in the 7-12 years than the 14-16 years age range (average 5.3Hz compared to 9.0Hz respectively). Curiously putting a 300 gram weight on the fingers of young (7-12 years old) children increases the tremor frequency from 5.3Hz to 8.2Hz, whilst in teenagers and adults it has no effect on tremor frequency. When electromyographic (EMG) recordings of tremor are made from children with ET, the tremor has an alternating pattern between the flexor and extensor muscles of the forearm (i.e. the tremor is caused by bursts activity in the muscles of the finger flexors, then finger extensors, then flexors then extensors and so on).
Tremor in children may be associated with dystonia (sustained muscle spasms) or tics. In addition an over-active thyroid gland may cause tremor and so a blood sample for thyroid function tests may be required.
Very little is known about the treatment of ET in childhood, although small doses of propranolol (20-60mg) have been reported to help small numbers of children. There are no proper randomized placebo controlled studies of any treatment for ET in children.
The psychology of children is a very complex field. However, one way of preparing a child with ET for the almost inevitable school playground comments, is where possible, to be open about the condition.
Conclusion Essential tremor affects about 5% of children. It predominantly involves the hands and may produce disability and handicap by the second decade. When necessary small doses of propranolol may be helpful, although there are no controlled trials to prove that it is effective for ET in children (unlike adults where there is class A evidence to support its use). A common sense open approach about the condition is probably wise.Dr Peter G Bain MA MD FRCP Reader & Consultant in Clinical Neurology Division of Neurosciences, Charing Cross Hospital, Imperial College London
Essential Tremor in Children
Essential tremor (ET) is often thought of as an adult onset condition. However, it can start in early childhood affecting about 5% of children, predominantly involving the hands and there is often a family history of tremor. There are two kinds of hand tremor which are: Kinetic tremor only (i.e. tremor present only when the hands are moving) and Postural tremor only (i.e. tremor is visible when the hands are held outstretched) with some children experiencing both. The hand tremor leads to difficulty holding drinks, eating, writing, coloring, playing a musical instrument and sports.
Very little is known about the treatment of ET in childhood but it is helpful to be open about the condition, to discuss it and to have a common sense open approach. Children will often cope better than adults until school age when often a variety of problems such as writing, school meal times and comments from peers, may cause anxiety and embarrassment.
Essential tremor (ET) is often thought of as an adult onset condition. However, it can start in early childhood affecting about 5% of children, predominantly involving the hands and there is often a family history of tremor. There are two kinds of hand tremor which are: Kinetic tremor only (i.e. tremor present only when the hands are moving) and Postural tremor only (i.e. tremor is visible when the hands are held outstretched) with some children experiencing both. The hand tremor leads to difficulty holding drinks, eating, writing, coloring, playing a musical instrument and sports.
Very little is known about the treatment of ET in childhood but it is helpful to be open about the condition, to discuss it and to have a common sense open approach. Children will often cope better than adults until school age when often a variety of problems such as writing, school meal times and comments from peers, may cause anxiety and embarrassment.
