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BENIGN ESSENTIAL TREMOR

Benign essential tremor is a disorder of the nervous system that causes rhythmic shaking. Though it can affect any part of the body from the head to the legs, it most often affects the arms and hands. When it affects the head it results in the person making yes-yes or no-no movements. This uncontrollable shaking of benign essential tremor increases when the person moves or tries to do simple tasks like writing. Other factors that worsen this tremor include emotional stress, anger, hunger, fatigue, caffeine and temperature extremes.

Cause

Approximately 50 percent of the cases of benign essential tremor arise as a result of genetic mutations or changes in the genes. The cause of the other cases is not known.

Diagnosis

A diagnosis of benign essential tremor is made after the doctor listens to the symptoms and examines the patient. Though there are no diagnostic tests to make the diagnosis, the doctor can order blood tests and CT scans to rule out other conditions.

Treatment

The treatment of benign essential tremor includes the use of medications that relieve tremors like the beta blockers propranolol (Inderal), atenolol (Tenormin) and metoprolol (Lopressor). Side effects of these medications include tiredness, lightheadedness and heart problems.

Medications used to control seizures are prescribed for patients who do not respond to beta blockers. Examples of such medications include primidone (Mysoline), gabapentin (Neurontin) and topiramate (Topamax). Side effects of these drugs include nausea and drowsiness.

Tranquilizers are also used to treat patients whose tremors are worsened by tension or anxiety. Examples of such medications include alprazolam (Xanax) and clonazepam (Klonopin). Side effects of these medications include fatigue and sedation.

Botulinum toxin type A which is commonly known as Botox, may be used to treat patients with certain head tremors. This medication which is produced by the bacteria Clostridia botulinum, is injected into the muscles to paralyze them since it blocks the release of the neurotransmitter or signaling chemical known as acetylcholine which causes muscle contractions. Repeat injections are required since the effects usually last for a just a few months.

Deep brain stimulation (DBS) is a surgical procedure that is used to treat persons with severe benign essential tremor that does not respond to medication. In this operation the surgeon places electrodes in the part of the brain known as the thalamus. These are then connected to a battery operated pulse generator known as a neurostimulator that is implanted in the chest. This neurostimulator sends electrical impulses to the areas in the brain that control movement and stops the tremors.

Thalamotomy is another surgical operation that is used to treat this condition. In this procedure the thalamus is destroyed on one side of the brain to reduce the tremor.

The Gamma Knife is another treatment option for these patients since it delivers radiation to the affected part of the brain.

It is important to treat benign essential tremor since it progressively worsens over time and can spread from one arm to affect the other one as well as the legs. This condition can also become increasingly severe and reduce the patient’s quality of life by making it difficult for them to work or to perform day to day activities like drinking from a cup without spilling the contents, shaving and putting on makeup.

Research

The latest developments in the benign essential tremor field involve its treatment with focused ultrasound by The Swedish Neuroscience Institute. This painless procedure bombards the diseased parts of the brain with high intensity ultrasound from multiple angles.

Support

Supportive treatment for benign essential tremor pain includes physical therapy in which a structured exercise program is designed by a physical therapist to strengthen the muscles and improve coordination.

Occupational therapists can also help patients adapt to living with the condition. They may recommend adaptive devices like wrist weights, wide-grip pens and heavier crockery.

  IMG 6675 from KCA on Vimeo.

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