How Do I Choose the Best Essential Tremor Treatment?

Idiopathic tremor, also known as familial or benign idiopathic tremor, is an autosomal dominant genetic disease. It is the most common extrapyramidal disease and the most common tremor. About 60% of patients have a family history. Postural tremor is the only clinical manifestation of the disease. The tremor of this disease is common in the hand, followed by head tremor, and very few patients experience lower limb tremor. The tremor worsened during concentration, nervousness, fatigue, and hunger. Most cases temporarily disappeared after drinking and worsened the next day.

Basic Information

English name

essentialtremor

Visiting department

Neurology

Common locations

Hand, head

Common causes

genetic factors

Common symptoms

Postural tremor

Contagious

no

Causes of primary tremor

More than one third of the patients have a family history with autosomal dominant inheritance. Two disease-causing gene loci have been identified, which are located at 3q13 (FET1) and 2p22-25 (ETM or ET2).

Clinical manifestations of primary tremor

The disease is more than ten years old or early in adulthood. Tremor is the only clinical symptom. It manifests as postural or motor tremor, often involving one hand or both hands or head. The symptoms do not become apparent until later. In addition to appearance and social embarrassment, it usually does not cause disability. In some cases, tremor can prevent the hand from completing fine movements such as writing. When the laryngeal muscle is affected, it can affect pronunciation and the lower limbs are not affected. Patients often mention that a small amount of alcohol can significantly relieve symptoms, but it is short-lived and the mechanism is unclear. The examination is usually free of other signs of the nervous system.

Primary tremor treatment

Drug treatment

(1) -blocker propranolol, which needs to be taken from time to time; Almar has better effects, less side effects, and is more commonly used in clinical practice. ECG examination should be performed before taking the drug to rule out slow heart rhythm and conduction block.

(2) Epileptics Epileptics are also effective, but patients with idiopathic tremor are often very sensitive to this drug and should not be prescribed for epilepsy. They should be started in small doses.

(3) Alprazolam is occasionally effective in patients.

2. Other treatments

In a few patients with severe symptoms, one side predominantly and ineffective drug therapy, stereotactic thalamus destruction is feasible. Deep thalamic electrical stimulation (DBS) is an effective alternative therapy. DBS technology has its outstanding advantages over previous surgical methods. First, DBS is reversible and adjustable. The surgery does not damage the nerve nucleus, but only temporarily makes it in a state of electrical paralysis, improving nerve function. The degree and range of nerve nucleus paralysis can be adjusted by setting the current, voltage, frequency, and electrode position of electrodes in the deep brain . In the long days after surgery, it can also be continuously adjusted with the change of the condition, which can control the constantly developing and changing idiopathic tremor symptoms. Second, DBS is experiential. After the electrodes are implanted surgically, the patient can be adapted, experienced, and observed through temporary stimulation to determine the final and optimal electrode implantation site. Again, DBS is developable. Surgery preserves the nerve function of normal brain tissue, creating conditions for new methods that may emerge in the future, and it also reserves the right and hope for patients to obtain a new life. Finally, DBS is two-sided. The symptoms of patients with bilateral idiopathic tremor can be effectively controlled, and bilateral pale bulbs or thalamus are damaged, which is prone to serious complications. In addition, DBS rarely causes side effects, which is an important reason why patients are willing to accept it.