Essential Tremor

 

Alternative Names:  Tremor – essential; Familial tremor; Tremor – familial

Definition:
Essential tremor is a disorder of the nervous system that causes a rhythmic shaking. Essential tremor (ET) goes by many names (benign essential tremor and familial tremor being two others), but regardless of the name it is characterized by a shaking in primarily the hands and arms, but it can be found in the jaw and throat and even more rarely the legs. ET is a widely varying disease that can affect many body parts and can vary in its intensity. Some people have a minor tremor in their hands, while others will have a highly noticeable tremor that affects the afflicted’s quality of life and can be mistaken for Parkinson’s Disease by the lay person. Many diseases have a tremor associated with them, but what sets ET apart from other diseases is its lack of any symptom outside of the tremor. Most people will never be diagnosed as having ET, and even when diagnosed there are few treatments available. Essential tremor is inherited by more people on a year by year basis than any other movement disease, this being because it is a simple dominant autosomal trait……...click & see

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Although usually not a dangerous condition, essential tremor worsens over time and can be severe in some people.Essential tremor can occur at any age but is most common in older adults……....you may click  to read more

Symptoms:
The tremor is usually most obvious in the hands, but may affect the arms, head, eyelids, or other muscles. The tremor rarely affects the legs or feet. People with essential tremor may have trouble holding or using small objects such as silverware or a pen.

The shaking usually involves small, rapid movements — more than 5 times a second.

Specific symptoms may include:

*Begin gradually

*Worsen with movement

*Usually occur in the hands first, affecting one hand or both hands

*Are aggravated by emotional stress, fatigue, caffeine or extremes of temperature

*Head nodding (Can include a “yes-yes” or “no-no” motion of the head)

*Shaking or quivering sound to the voice if the tremor affects the voice box

*Difficulty writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

*Occur when you move (action-related tremor), and may be less noticeable with rest

*Come and go, but generally get worse as you age

*Get worse with stress, caffeine, and certain medications

*Not affect both sides of the body the same way

Essential tremor vs. Parkinson’s disease

Many people associate tremors with Parkinson’s disease, but the two conditions differ in key ways:

*When tremors occur. Essential tremor of the hands typically occurs when you use your hands. Tremors from Parkinson’s are most prominent when your hands are at your sides or resting in your lap.

*Associated conditions. Essential tremor doesn’t cause other health problems, whereas Parkinson’s is associated with a stooped posture, slow movement and a shuffling gait. However, people with essential tremor may sometimes develop other neurological signs and symptoms — such as an unsteady gait (ataxia).

*Parts of body affected. Essential tremor can involve your hands, head, voice and legs. Tremors from Parkinson’s typically affect your hands but not your head or voice.

Causes:
Essential tremor is the most common type of tremor. In general, tremors occur when there is a problem with the nerves supplying certain muscles. However, everyone has some essential tremor but the movements are usually so small that they can’t be seen.

About half of essential tremor cases appear to occur because of a genetic mutation. This is referred to as familial tremor. What causes essential tremor in people without a known genetic mutation isn’t clear.

Some research suggests that the cerebellum, the part of the brain that controls muscles movements, does not work correctly in patients with essential tremor.

Noticeable essential tremors can be seen at any age but are most common in people older than 65.

Essential tremor can also occur with other neurological conditions, including dystonia, parkinsonism, and certain inherited nerve conditions such as Charcot-Marie-Tooth disease.

If an essential tremor occurs in more than one member of a family, it is called a familial tremor. This type of essential tremor is passed down through families (inherited), which suggests that genes play a role in its cause.

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Familial tremor is usually a dominant trait, which means that you only need to get the gene from one parent to develop the disorder. It usually starts in early middle age, but may be seen in people who are older or younger.

Risk Factors:
There are two known risk factors for essential tremor:

*Genetic mutation. The inherited variety of essential tremor is an autosomal dominant disorder, which means that a defective gene from just one parent is needed to pass on the condition. If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.

*Age. Essential tremor is more common in middle age and older.

Complications:
Essential tremor is not life-threatening, but symptoms often worsen over time. If the tremors become severe, you may find it difficult to:

*Hold a cup or glass without spilling

*Eat normally

*Put on makeup or shave

*Talk, if your voice box or tongue is affected

*Write — handwriting may become increasingly large, shaky and illegible

Diagnosis:

Your doctor can make the diagnosis by performing a physical exam and asking questions about your medical and personal history.

A physical exam will show shaking with movement, usually small movements that are faster than 5 times per second. There are usually no problems with coordination or mental function.

Further tests may be needed to rule out other reasons for the tremors. Other causes of tremors may include:

•Alcohol withdrawal
•Cigarette smoking
•Hyperthyroidism
•Pheochromocytoma
•Too much caffeine
•Use of certain medications
•Wilson’s disease
Blood tests and imaging studies (such as a CT scan of the head, brain MRI, and x-rays) are usually normal.
The most common way to diagnose ET is by having a patient draw the Archimedes Spiral, which is shown immediately below.

If there is a shakiness detected while drawing the spiral, ET can be diagnosed assuming there are no neurological or biological reasons to be found. Below is a picture of what the Archimedes Spiral looks like when drawn by a person with a relatively severe tremor:

Treatment:
Treatment may not be necessary unless the tremors interfere with your daily activities or cause embarrassment.

When diagnosed with ET there are several courses of action depending on the severity of the tremor.
Medicines may help relieve symptoms. How well medicines work depend on the individual patient.

Two medications used to treat tremors include:

•Propranolol, a drug that blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline
•Primidone, an antiseizure drug that also controls the function of some neurotransmitters
The drugs can have significant side effects.

Side effects of propranolol include:

•Fatigue
•Nose stuffiness
•Shortness of breath (people with asthma should not use this drug)
•Slow heart beat
Side effects of primidone include:

•Drowsiness
•Difficulty concentrating
•Nausea
•Problems with walking, balance, and coordination
Other medications that may reduce tremors include:

•Antiseizure drugs such as gabapentin and topiramate
•Mild tranquilizers such as alprazolam or clonazepam
•Blood pressure drugs called calcium-channel blockers such as flunarizine and nimodipine
Botox injections, given in the hand, have been used to reduce tremors by weakening local muscles.

In severe cases, surgery to implant a stimulating device in the brain may be an option.

Prognosis:

An essential tremor is not a dangerous condition, but some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, eating, or drinking.

Prevention:
Stress and caffeine can make tremors worse. Avoid caffeinated drinks such as coffee, tea, and soda, and other stimulants. Exercise and counseling to reduce emotional stress may also help.

Alcoholic beverages in small quantities may decrease tremors but can lead to alcohol dependence and alcohol abuse, especially if you have a family history of such problems. How alcohol helps relieve tremors is unknown.


Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://wiki.ggc.usg.edu/mediawiki/index.php/Essential_Tremor
http://www.mayoclinic.com/health/essential-tremor/DS00367
http://www.nlm.nih.gov/medlineplus/ency/article/000762.htm

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