Essential Tremor
What is Essential Tremor (ET)?
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ET is a condition that causes rhythmic movements when a patient goes to do something (use a tool, eat, drink, write, carry something).
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This is different from the movement or tremor in Parkinson disease (PD) as the tremor in ET occurs with action and that which occurs in PD is at rest.
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Most often there is a family history of tremor.
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ET often responds temporarily to alcohol.
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The tremor in ET worsens with fatigue, stress, sleepiness, or increased emotion.
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The tremor can be mild often not coming on unless the patient is very anxious, severe affecting the patient's quality of life and day to day function, or anywhere in between.
How do I know if I have ET?
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The diagnosis is made based on the history and the exam but should only be performed by a physician. Each person is different and medical expertise is important.
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On history, patients describe:
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Tremor occurring when performing an action
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May improve with alcohol
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Tremor worsens with stress, anxiety, fatigue, and sleepiness.
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On the exam, your movement disorder specialist (MDS) will find:
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no evidence for parkinsonism (stiffness, slowness, or resting tremor)
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A tremor that can affect both sides or one side.
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A tremor in the head, voice, arms, hands, legs, and even an "internal" tremor sensation.
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Spirals have a sinusoidal appearance
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Gait and balance may be affected.
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What can be done about it and what is the treatment?
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The first question to determine is if the tremor is bothersome to the patient in his or her everyday life.
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If not, no treatment is needed.
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If it is bothersome, the Movement Disorder Specialist (MDS) may prescribe primidone (an old seizure medication), propranolol (beta-blocker), or a host of other medications used for different purposes in neurology but also for tremor.
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The MDS will find the med and dose that works for the patient.
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Every patient is different and often combinations of medicines are needed.
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For those patients who have medicine-resistant tremor, deep brain stimulation (DBS) can be used and has been used for years as a life changing treatment for tremor. Newer therapies such as MRI-guided focused ultrasound are also being used in some centers.
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There is also a device called the Cala Trio, which is a wrist-worn device which provides peripheral stimulation and shown to improve tremor in up to 70% of patients.