Essential Tremor

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Image source: health.clevelandclinic.org

BY: ALLISON BROWN

Recently, a very special family friend asked me if I could write an article about Essential Tremor (ET).  I was quite happy to learn that I do have a following of readers who look forward to my article bi-weekly.  I am humbled by the opportunity to share health information as a way of giving back to my community.  So, I want to say a great big “thank you” to all of you who read my articles.

ET presents with shaking or “tremors” in various parts and on different sides of the body. The areas mainly affected include the hands, arms, head, larynx, tongue, and chin. The lower body is less affected.

It is said that the thalamus in the brain processes the abnormal electrical brain activity and subsequently causes tremors.  In half of the people who present with ET genetics is thought to be the cause.  So, a child born to a parent with ET will have a 50% chance of inheriting the responsible gene, though may never actually experience symptoms.  ET is much more common in older adults and symptoms become more pronounced with age according to WebMD. (http://www.webmd.com/brain/essential-tremor-basics#1)

The primary symptoms associated with ET include:  uncontrollable shaking that occurs for brief periods of time, shaking voice, nodding head, tremors that worsen during periods of emotional stress, tremors that get worse with purposeful movement, tremors lessen with rest, and balance challenges (in less often noted cases). (http://www.webmd.com/brain/essential-tremor-basics#1).

ET is linked to other movement disorder such as Parkinson’s disease and migraine headaches, and depression as a result of some medical therapy. Some individuals can be misdiagnosed as having ET when it is Parkinson’s disease and vice versa.  The diagnosis of ET is as a result of examination of symptoms by a physician and a complete neurological exam, there is no specific blood, urine or other test used to diagnose ET.

Treating ET can be in the form of oral drugs that reduce the tremors.  Medications encompass Inderal, Mysoline, Neurontin, and Topamax.  Tranquilizers such as Ativan, Klonopin, Valium, and Xanax are also used.  Botox is also an option for vocal and head tremors.  Surgical options include deep brain stimulation (DBS) for those suffering from severe tremors despite medical therapy.  DBS is the use of a surgical implantation of electrical leads into the thalamus of the brain. Focus ultrasound is the use of MRI images to focus ultrasound to destroy tissue in the thalamus; patients are awake and responsive during the entire treatment. (http://www.webmd.com/brain/essential-tremor-basics#1)

As there is no cure for ET the treatments do provide relief of symptoms and thus increase the quality of life. Not every treatment or procedure is effective for every person with ET.  A physician will work with you to develop and recommend an individualized treatment plan, including lifestyle changes that may help to reduce tremors.

Health Canada has just recently approved INSIGHTEC’s Exablate Neuro system for the treatment of ET.  Data presented to Health Canada demonstrated a clinically meaningful effect of the treatment making the disease more manageable and less debilitating. Due to its non-invasive nature, the procedure is performed while the patient is fully conscious, with no incisions and no anesthesia. The results are immediate and the patient is able to return to normal activities within days.  “This is a major breakthrough in the treatment of Essential Tremor,” said Andres Lozano, MD, Dan Family Professor and Chairman of Neurosurgery at Toronto Western Hospital, University of Toronto. “We are excited to offer our patients a new, minimally-invasive therapy to control their tremors and effectively treat their debilitating symptoms. The patients we have treated so far with this technique have had significant relief of their tremor and a very quick recovery with minimal adverse events”, he emphasized. (https://www.insightec.com/news-events/press-releases/2016/health-canada-approves-insightec-s-exablate-neuro-system-for-the-treatment-of-essential-tremor)

There are numerous support groups such as Essential Tremor Canada and Essential Tremor Toronto that can be accessed online for further information. This article is dedicated to Theresa Ross and family. Special thanks to Anton Ross who because of her tenacity and love for her family member, she researched the information and helped the doctors get on the right track to diagnosis and treatment. Thank you for the opportunity to serve you through providing health education information. 

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