Essential Tremor Treatment Guidelines

Essential tremor is a movement disorder that causes trembling, usually of the hands. It can also sometimes affect the head, causing a "yes" or "no" nod, or the voice, creating a tremulous sound. Essential tremor is not life-threatening, and is the result of improper communication between one part of the brain and another.

Though the condition can be difficult to treat, there are medications and other therapeutic avenues to be explored.

Diagnosis

• The first step toward a diagnosis of essential tremor is ruling out other conditions that cause tremors. Parkinson's disease and other Parkinsonian tremors differ in that they generally occur when the hands are at rest. Essential tremor is more likely to appear during exertion.

  There is no specific neurological test for the disorder, but a doctor may check thyroid and other functions to rule out possible causes. He may ask some important questions regarding family history and past injuries. These questions also serve to rule out other possibilities, and to identify a possible genetic connection, as it appears essential tremor is passed on through an inherited defect.

  The doctor may also have you complete some simple tasks, like drawing a spiral or drinking from a glass.

Consequences

• Essential tremor is not life-threatening, and it is not a precursor to any other physical issue. You and your doctor may decide not to treat it at all. However, depending on the severity, essential tremor can result in certain compromises and quality of life issues.

  Individuals with essential tremor may experience difficulty eating, writing, shaving, and performing other simple daily tasks.

Drug Treatment

• Beta blockers, designed for treatment of high blood pressure, can help some individuals with essential tremor. It's important to consider that people with certain heart issues, diabetes, or asthma are not good candidates for this treatment option.

  Tranquilizers, in particular Valium and Xanax, are sometimes prescribed for those who find their tremors worsening with stress or anxiety. These medications can interfere with tasks, however, because they sometimes produce memory loss, confusion, and drowsiness. Risk of addiction warrants that use of these drugs be closely supervised.

  Anti-seizure medicines like gabapentin and topiramate can be helpful for some people, especially those unable to take beta blockers. The flu-like symptoms and sleepiness these drugs produce are usually only temporary side effects.

Botox

• As strange as it may seem, Botox, or Botulinum toxin type A, can help relieve some aspects of essential tremor. This solution is mostly used when the patient exhibits head and voice symptoms, and it is less effective for hand tremors, as it can cause weakness if injected in that area of the body.

Therapy and Lifestyle

• Some exercises can reduce tremors by improving muscle control and coordination. Therapists may also suggest certain changes to help control the problem, like using heavier plates and glasses, wider pens, and wrist weights.

  Rest and relaxation are important for essential tremor sufferers, as tremors can be worsened by stress or tiredness. Alcohol and caffeine can also contribute negatively.

Surgical Option

• As a last resort, surgery can help individuals whose tremors are highly disruptive and who have not responded to drug treatment. Deep brain stimulation, though drastic, can provide significant relief. A probe is inserted into the thalamus, the portion of the brain that controls tremors. A device is placed under the skin of the chest that sends harmless electrical impulses along the probe, interrupting tremor signals.