22 years
Can you please explain for me a bit about it ?
Nov 18, 2014
Benign essential tremor (ET) is the most common movement disorder and primarily involves shaking in the hands. Patients with ET typically experience tremors when the arms are held up (such as while reading a newspaper) and when the hands are being used for activities like eating, drinking or writing. It may also cause shaking of the head, voice, tongue and legs and worsen with stress, fatigue and stimulant medications. It occurs in about 5% of older adults. It is a progressive, often inherited disorder that usually begins in later adulthood.
Two types of tremor are common with ET:
• Postural tremor—shaking in certain positions only, such as with arms outstretched
• Kinetic or action tremor—shaking that gets worse during activities, such as eating or shaving
ET can be socially isolating in some cases. It may interfere with normal daily activities such as writing or speaking.
Causes
For some people, ET is caused by a genetic mutation. For others, the cause is not clear. The hypothesis is that ET may be caused by electrical fluctuations in the brain with abnormal signals being sent out to the muscles. Several areas of the brain have been implicated to be responsible for generating these abnormal signals. The signals travel through a variety of brain regions before reaching the muscles. These regions include the cerebellum, red nucleus, globus pallidus, thalamus and cortex. Interruption of tremor signals along this pathway may explain why thalamic (ventral intermediate thalamus - Vim) stimulation using a surgically implanted device is often effective in treating essential tremor.
Risk Factors
Family history of tremors is the only known risk factor for ET. The condition may occur at any age. It is more likely to occur in teens and people older than 50 years old.
Symptoms
ET is generally not a serious condition, but its severity may vary and worsen over time. Symptoms may include:
• Tremor that occurs when standing or moving the limbs, but not usually at rest
• Uncontrollable, rhythmic movement
• Shaking most common in hands, arms, head, or voice
• Shaking only in certain positions or during activity
• Trouble with fine motor skills such as drawing, sewing, or playing an instrument
• Shaking that gets worse from caffeine, stress, fatigue, or heat
• Shaking that may decrease when using alcohol
• Hearing loss
• Problems with social, functional, or job-related abilities in more severe cases
It is not a necessary cause-effect relationship when it comes to the diagnosis tremors and other related health conditions.
Diagnosis
Diagnosis of ET is based upon symptoms and medical and family history. A thorough physical exam, with special attention to the central nervous system, is also necessary. There are no special tests to diagnose ET.
Treatment
- Most people with ET do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:
• Staying well-rested
• Avoiding caffeine
• Avoiding stimulants often found in over-the-counter medications, like cold remedies
• Avoiding temperature extremes
- Patients with significant functional impairment usually opt for some form of treatment. Some patients that aren’t functionally impaired desire treatment because their tremor is a significant source of embarrassment. Once a patient desires therapy, there are several options:
1. Non-Medical Therapy
In some patients, tremors can be reduced by weighting the limb, usually by applying wrist weights. In a small proportion of patients, this can dampen down the tremor enough to provide some relief or improve functioning.
Since anxiety and stress classically make the tremor worse, non-medical relaxation techniques and biofeedback can be effective in some patients.
Medications known to make tremors worse should be eliminated or minimized when possible. These include lithium, several antipsychotics, valproic acid, corticosteroids, some anti-depressants and a class of drugs called adrenergic agonists. People with tremor also may benefit from avoiding dietary stimulants, such as caffeine. They should also be evaluated for hyperthyroidism, which can produce tremors that mimic ET.
2. Medication
• Beta-blocker
• Anti-seizure medications
• Benzodiazepines
• Antipsychotics
• Botulinum injections
3. Surgery
Surgery may be an option in rare cases where tremors are disabling and medications don’t help. Two approaches are possible.
• Deep brain stimulation (DBS)—sends painless electrical pulses to the brain, interrupting faulty signals
• Thalamotomy—destroys a tiny part of the brain (less commonly performed than DBS)
Two types of tremor are common with ET:
• Postural tremor—shaking in certain positions only, such as with arms outstretched
• Kinetic or action tremor—shaking that gets worse during activities, such as eating or shaving
ET can be socially isolating in some cases. It may interfere with normal daily activities such as writing or speaking.
Causes
For some people, ET is caused by a genetic mutation. For others, the cause is not clear. The hypothesis is that ET may be caused by electrical fluctuations in the brain with abnormal signals being sent out to the muscles. Several areas of the brain have been implicated to be responsible for generating these abnormal signals. The signals travel through a variety of brain regions before reaching the muscles. These regions include the cerebellum, red nucleus, globus pallidus, thalamus and cortex. Interruption of tremor signals along this pathway may explain why thalamic (ventral intermediate thalamus - Vim) stimulation using a surgically implanted device is often effective in treating essential tremor.
Risk Factors
Family history of tremors is the only known risk factor for ET. The condition may occur at any age. It is more likely to occur in teens and people older than 50 years old.
Symptoms
ET is generally not a serious condition, but its severity may vary and worsen over time. Symptoms may include:
• Tremor that occurs when standing or moving the limbs, but not usually at rest
• Uncontrollable, rhythmic movement
• Shaking most common in hands, arms, head, or voice
• Shaking only in certain positions or during activity
• Trouble with fine motor skills such as drawing, sewing, or playing an instrument
• Shaking that gets worse from caffeine, stress, fatigue, or heat
• Shaking that may decrease when using alcohol
• Hearing loss
• Problems with social, functional, or job-related abilities in more severe cases
It is not a necessary cause-effect relationship when it comes to the diagnosis tremors and other related health conditions.
Diagnosis
Diagnosis of ET is based upon symptoms and medical and family history. A thorough physical exam, with special attention to the central nervous system, is also necessary. There are no special tests to diagnose ET.
Treatment
- Most people with ET do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:
• Staying well-rested
• Avoiding caffeine
• Avoiding stimulants often found in over-the-counter medications, like cold remedies
• Avoiding temperature extremes
- Patients with significant functional impairment usually opt for some form of treatment. Some patients that aren’t functionally impaired desire treatment because their tremor is a significant source of embarrassment. Once a patient desires therapy, there are several options:
1. Non-Medical Therapy
In some patients, tremors can be reduced by weighting the limb, usually by applying wrist weights. In a small proportion of patients, this can dampen down the tremor enough to provide some relief or improve functioning.
Since anxiety and stress classically make the tremor worse, non-medical relaxation techniques and biofeedback can be effective in some patients.
Medications known to make tremors worse should be eliminated or minimized when possible. These include lithium, several antipsychotics, valproic acid, corticosteroids, some anti-depressants and a class of drugs called adrenergic agonists. People with tremor also may benefit from avoiding dietary stimulants, such as caffeine. They should also be evaluated for hyperthyroidism, which can produce tremors that mimic ET.
2. Medication
• Beta-blocker
• Anti-seizure medications
• Benzodiazepines
• Antipsychotics
• Botulinum injections
3. Surgery
Surgery may be an option in rare cases where tremors are disabling and medications don’t help. Two approaches are possible.
• Deep brain stimulation (DBS)—sends painless electrical pulses to the brain, interrupting faulty signals
• Thalamotomy—destroys a tiny part of the brain (less commonly performed than DBS)
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