Essential tremor
(ET)
Essential Tremor
- sometimes referred to as
Benign Essential Tremor
- is a fine to
moderate
tremor which has no
known cause. Tremors
are rhythmic, involuntary, alternating movements
which may affect any part of the body.
Treatment
Most people with essential tremor don't need treatment beyond
reassurance that the condition isn't a sign of a more serious disease.
Lifestyle changes, which include avoiding stressful situations and
stimulants such as caffeine, may help ease the tremors. If the disorder
is keeping you from doing the things you enjoy, your doctor may
recommend these options:
Medications
Medications provide relief from tremor about 40 percent to 60 percent of
the time. They include:
-
Beta blockers.
Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in about 50 percent of
people. Possible side effects include dizziness, fatigue, nausea,
and impotence. Because beta blockers are especially likely to cause
confusion and memory loss in older adults, they may be a better
choice for younger people. They also may not be an option if you
have asthma, diabetes or certain heart problems.
-
Antiseizure
medications.
These drugs, especially primidone (Mysoline), may be effective in
people who don't respond to beta blockers. The main side effects are
drowsiness and flu-like symptoms, which usually disappear in time.
-
Tranquilizers.
Drugs such as diazepam (Valium) and alprazolam (Xanax) are sometimes
used to treat people whose tremors are made much worse by tension or
anxiety. Side effects can include confusion and memory loss.
-
Carbonic
anhydrase inhibitors.
Sometimes drugs such as methazolamide (GlaucTabs, Neptazane) or
acetazolamide (Diamox) — commonly used to treat the eye disease
glaucoma — may be effective when other medications are not.
-
Botulinum toxin
(Botox) injections.
You're probably familiar with Botox as a treatment for facial
wrinkles, but it can also be useful in treating some types of
tremors, especially of the head and voice. When used to treat hand
tremors, Botox can sometimes cause weakness in your fingers.
Surgery
Surgery may be an option for people whose tremors are severely disabling
and who don't respond to medications:
-
Thalamotomy.
This procedure may help the small number of people whose essential
tremor is disabling. Thalamotomy involves destroying a tiny part of
your thalamus — a message relay center deep within your brain.
Destruction of a small region of the thalamus on one side of your
brain typically relieves tremor on the opposite side of your body.
Between 70 percent and 80 percent of people who undergo the
operation experience substantial relief from essential tremor.
However, the operation as usually performed can relieve tremors only
on one side of your body. Surgeons usually don't operate on both
sides of the thalamus because doing so poses a risk of speech loss
and other complications.
-
Deep brain
stimulation (DBS).
A treatment involving a brain implant device called a thalamic
stimulator may be appropriate if you have severe tremors and
medications aren't effective. A pacemaker-like chest unit transmits
electrical pulses through a wire to a lead implanted in your
thalamus. The pulses, which are painless, may interrupt signals from
your thalamus that help cause tremors. You turn the pulse generator
on and off by passing a magnet over your chest. This procedure
doesn't pose the risks of thalamotomy and can be performed on both
sides of your brain.
