Essential tremor: symptoms, causes and treatments

Essential tremor is common in the general population. Within movement disorders, it is the most common pathology, greatly surpassing Parkinson's disease. Statistically, it is twenty times more prevalent than Parkinson's among adults.

The age group most affected are people over sixty-five years old. But it is considered that, between the ages of forty and sixty, there is the most common age for presenting the first symptoms. There have also been cases in infants.

The characteristic of essential tremor is the involuntary movement in the form of persistent shaking. The manifestation occurs especially in upper limbs: hands and arms. Episodes usually appear symmetrically and with pauses.

While it is a chronic situation, which lasts over time, It is not present throughout the day and, sometimes, not even every day.

The essential tremor is not deadly, it is not associated with cognitive deterioration nor to degenerations of the nervous system. However, although it is classified as benign, it is a very important disorder for those who suffer from it.

We can say that represents a cause of disability for activities of daily life, how to write, have a cup of tea or tie your shoes.

Causes of essential tremor

There are not enough studies in the scientific world to arrive at the cause of the origin of the pathology. This is because it is a benign disorder, with slow evolution.

However, it is known that essential tremor it is referred to an alteration in the connections of the nervous system in the nuclei of the movement. The thalamus, the nigrostriatal pathway and the cerebellum are regions of the nervous system responsible for regulating body movements.

The scientific hypothesis is that, in essential tremor, some of those regions have an abnormal change which finally produces the involuntary movement.

The existence of family cases, where parents and children suffer essential tremor, confirms in the first instance a genetic component of the alteration. In fact, an equivalent name for the essential tremor is 'family tremor'.

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Symptoms of essential tremor

First, we must differentiate it from Parkinson's. The key fact is that in the essential tremor involuntary movements happen when the person makes a specific movement or try to maintain a position. In Parkinson's, involuntary movements are at rest.

In addition to the key sign, which is tremor in the upper limbs, The following symptoms can be added:

  • Changes in the voice: The essential tremor can affect the larynx, altering the generation of voice in the vocal cords.
  • Pitching: as if the person said "yes" or "no" with the head, but involuntarily.
  • Problems to specify activities of daily life: Sometimes, the tremor is not evident enough, but the person realizes that it is difficult for him to grab something, handle a tool or simply write.

If left untreated, the symptoms tend to get worse with age and aging. It has been shown to worsen and become more repetitive when the person consumes a lot of caffeine. Also in situations of stress or before the bad night rest.

Although it has been shown that the intake of small amounts of alcohol improves symptoms, it is not an absolute medical recommendation.

Treatment options

We must clarify that there is no curative treatment for essential tremor. The hygienic-dietetic measure that is always indicated is to suspend the consumption of caffeine. For stress, various courses of action are recommended, such as psychotherapy or medication for falling asleep.

Some patients benefit from kinesiotherapy and physiotherapy sessions aimed at improving muscle control and increasing balance coordination.

As for the use of pharmacological treatment, we can mention the following drugs as the most used and those that more evidence in their favor have:

  • Propanolol: It is a beta-blocker. Possibly, the most effective to reduce symptoms. It should be used with care in patients with cardiac pathologies, especially if there is a history of blockages, and always supervised by a professional.
  • Primidone: It is an anticonvulsant.
  • Antidepressants: in order to control the stress that could underlie.
  • Ansiolíticos: to control stress and to regularize sleep.
  • Botulinum toxin: It is used in injectable doses in certain areas of the body, mainly head and hands.

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If all the above does not work, more complex treatments are currently used. These are reserved for patients with very low response drugs and with a disabling clinical picture. We can name the following therapeutic options:

  • Stereotactic radiosurgery: is the use of high power radio frequency rays focused on a specific area of ​​the nervous system.
  • HIFU: It is the same foundation as the previous technique, but in this case with ultrasound rays.
  • Implantation of a stimulator: a device is placed that will send electrical stimuli to the thalamus.
  • Thalamotomy: It is the excision of parts of the thalamus by surgery. Nowadays, the traditional technique is replaced by the use of radiosurgery or HIFU, which avoids surgical invasion.