Treatments for ET
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Medication ​
Medication There are two main 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.

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.

Learn more about Essential Tremor

Essential Tremor is caused by overactive cells in the area of the brain called the thalamus. The thalamus is about the size of a walnut and within the brain there are two of them. If there are overactive cells in the right thalamus, the person will have signs of tremor on the left side and vice versa. Some patients suffer from tremor on both sides.

Surgery
​ If medicine treatment is not effective, and the tremor is severe, then a surgical procedure may be an option. There are three surgical procedures that may be considered - thalamic deep brain stimulation (DBS)plus there are alternative less invasive treatment options for Essential Tremor such as the Gamma Knife thalamotomy and the other is Neuravive. 
They involve the thalamus. This is a deep part of the brain that organizes messages travelling between the body and brain. 
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​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.


Neuravive Focused Ultrasound
Similar to Gamma Knife’s approach, Neuravive aims to target and destroy the brain cells that are causing the patient to experience a tremor. However, Neuravive uses MR-guided to treat the cells instead of ionized radiation. This technique has already seen success in treatment for uterine fibroids, prostate cancer, and other conditions. Patients often do not have to wait for results and generally enjoy a decreased tremor immediately following the procedure. Neuravive’s results are also not reversible or adjustable due to brain lesioning.
While patients have experienced positive results from Gamma Knife and Neuravive, results may vary from case to case.




Guided Focused Ultrasound Treatment for Essential Tremor Now Covered by Medicare
​INSIGHTEC MR guided Focused Ultrasound combines two proven technologies - High intensity focused ultrasound and Magnetic Resonance Imaging (MRI).


Gamma Knife
The Gamma Knife procedure Is a non-surgical treatment using highly focused radiation to kill the cells causing the tremor. Overactive cells in this area can cause hand tremors in patients, and the ionizing radiation used during the procedure destroys the affected area without harming the surrounding, healthy tissue. Patients who opt for Gamma Knife generally see results within three to six months after the procedure, and they also experience lower complication rates in comparison to conventional surgery options. Because Gamma Knife destroys the affected cells, the results are not reversible or adjustable.

The thalamus is a small structure within the brain located just above the brain stem between the cerebral cortex and the midbrain and has extensive nerve connections to both. The main function of the thalamus is to relay motor and sensory signals to the cerebral cortex. It also regulates sleep, alertness and wakefulness.

Alternatives
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.
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What are Stem Cells?
Stem cells are the body's raw materials — cells from which all other cells with specialized functions are generated. Under the right conditions in the body or a laboratory, stem cells divide to form more cells called daughter cells.

These daughter cells either become new stem cells (self-renewal) or become specialized cells (differentiation) with a more specific function, such as blood cells, brain cells, heart muscle or bone. No other cell in the body has the natural ability to generate new cell types.
 
Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.

Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can be induced to become tissue- or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.
Essential tremor and Cannabinoids
Today, cannabis and its derivatives are being widely studied for these purposes in everything from mental illness to pain relief to degenerative disease. Neurological conditions like Parkinson's and Essential Tremor are deep in the mix, too. Find out more about what's being discovered... Go to ET & Cannabinoids
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.

Research Study 
Scientists at the National Institute of Neurological Disorders and Stroke are evaluating the effectiveness of 1-octanol, a substance similar to alcohol but less intoxicating, for treating essential tremor. Results of two previous NIH studies have shown this agent to be promising as a potential new treatment.
Scientists are also studying the effectiveness of botulinum toxin as a treatment for a variety of involuntary movement disorders, including essential tremor of the hand.


Avoid caffeine. Caffeine and other stimulants can increase tremors

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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.

DIAGNOSIS QUESTIONS

How is essential tremor diagnosed? ​
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