What is Essential Tremor?

http://www.tremor.org.uk/about.html ^

[Brookhaven]

Tremor is a normal phenomenon which is experienced by everyone. Normal tremor is referred to as "physiological tremor" and it is the slight tremor that any person will see when they, for instance, put out their hands. This tremor can be exaggerated in certain situations such as those associated with anxiety and fatigue. This is usually referred to as "exaggerated or enhanced physiological tremor".

In general, many members of the National Tremor Foundation (NTF) have pathological tremors. That is, their tremor or tremors are inappropriate in size and may interfere with normal functioning or present as a "cosmetic nuisance".

Tremor can be a common symptom of neurological disease and may be due to trauma, tumor, stroke or degenerative disease. The most common tremor condition is idiopathic or essential (cause unknown) or hereditary tremor. In fact, essential tremor is one the most common of all neurological conditions. It is estimated that four to five million people in the United States alone have such tremor. In most cases the disease runs in families. The condition is transmitted as an autosomal dominant inheritance, which means that the offspring of an affected individual will have a fifty percent chance of also having the illness.

Essential tremor is a neurological disorder in which patients exhibit a rhythmic trembling of the hands, head, legs, trunk and/ or voice, which is more visible during movement or with arms outstretched, than at rest. It is recognisable when seen in postural (voluntarily maintaining a position against gravity) and kinetic (performing any kind of movement) positions. Thus, essential tremor is considered an "action" tremor. It is not believed to be associated with any disease or condition.

It can affect persons of any age, gender (both genders are equally affected) and race, it can start in adolescence or adulthood and in the majority of cases, it is inherited. The mean age at onset is 45 years. While more commonly seen in older individuals, ET can begin as early as birth. The age of onset, body part(s) affected and the severity of the tremors, typically differ from patient to patient, even within the same family. This difference from patient to patient holds true for benefits received from drug therapy as well. When tremor begins ins the very elderly it has sometimes been called senile tremor The condition is slowly progressive and tremors will worsen overtime. Some individuals may have to change occupations (i.e. dentists and draftsman) or have to take early retirement.

Tremor may involve different body pains. Most often the hands are affected. Usually the dominant hand is first affected and eventually both hands may be involved. Handwriting becomes less legible and drinking liquids is difficult to manage. The individual may have to use both bands or use a straw to drink. Eating soup may become impossible. It may no longer be possible to sign a cheque in a bank or serve coffee at a luncheon. Dysfunction with fine manipulation and embarrassment are also problems. Tremor of the head may also occur. The shakiness may be a 'yes-yes" or a "no-no" movement. Embarrassment and social withdrawal may result from head tremor. Shakiness of the voice may occur which gives a quavering intonation to speaking. Tremor of the trunk and legs is seen in some patients.

Tremor is the sole symptom of this disorder and other neurological problems rarely occur. Stress and social interaction usually worsen the tremor. Small amounts of alcohol may be helpful. Unfortunately physicians who may misdiagnose it as anxiety or Parkinson's disease do not often recognise the tremor. There is also the misconception that nothing medically can be done to relieve the tremor.

Little is known about what causes this tremor, hence the eponym essential or idiopathic, which means that the cause is unknown, as with essential hypertension. Essential tremor is certainly a disorder of the central nervous system. However, it is not known what area of the brain is involved. It is also unclear why the disease occurs and how it affects the brain. A better understanding of these mechanisms would lead to better treatment and/or preventive therapy.

[Brookhaven]

I mentioned I had this on another post. Since I got a couple of questions about it, I thought I would post some info.

I am one of the "rare" cases where it was present since birth. I can testify from experience that most doctors don't have a clue how to deal with this, even though (as the article states) it is not that uncommon, and even pretty common in the elderly.

I can't remember a single person I've talked to about it that actually knew what it was, but I can remember several people who have said "that sounds exactly like my husband (brother, wife, cousin, friend), I wonder if they have it."

Here are some additonal links to info:

http://www.bgsm.edu/bgsm/surg-sci/ns/tremor3.html Wake Forest Site - Good link list including the yahoo groups (formerly egroups) discussion group which seems to be the main mailing list on the internet.

http://www.essentialtremor.org/ International Essential Tremor Foundation - not much info on their website, but the only organization dedicated to promoting awareness of ET. U.S. based.

http://www.tremor.org.uk National Tremor Foundation - a British organization focusing on all types of tremor.

[firewalk]

BTTT

[ImaGraftedBranch]

You are not alone, pal. My mom had it, my sister had it, my brother had it and I have it. 4 of 8.

Been shaking since I was a young lad.

Just kinda strange when I show it to other people (when they ask), but it does not affect my typing (which is good), or my eating (which is obvious).

[RichardW]

It runs in my wife's family, including my wife. Symptoms can usually be controlled by Inderal, a beta blocker. Otherwise, it is usually considered to be a benign problem More embarrassing than anything. A person doesn't shake except when trying to do something requiring fine motor control such as handwriting.

[boris]

"Symptoms can usually be controlled by Inderal, a beta blocker."

Careful. Inderal is powerful and a bit perilous. It was an early beta-blocker and is still used. But if you stop taking it, or miss a couple of doses, or your doctor tapers you off of it too rapidly (as mine did), you can have Atrial Fibrillation, which is potentially dangerous.

More modern beta-blockers, like tenormin or sotalol, are safer and less touchy. I have no idea if they work on Essential Tremor, and I frankly cannot imagine why Inderal works on it.

But I'm just an engineer.

--Boris

[Paradox]

Thanks for the post. I believe my step-daughter may have this condition, in a mild form, but still noticable, and to her, troubling.

[boris]

Brookhaven: I don't have Essential Tremor, but I have diabetic peripheral neuropathy (very painful nerve damage caused by diabetes). I wonder if the medications I take might be helpful. Look into Neurontin (gaba-pentin), an anti-epileptic drug. Also Elavil (amitryptaline), an anti-depressant. These drugs are the only thing I've tried that help my pain. They do not remove it, only make it less severe. Ask a doctor--preferably a neurologist. Probably he'll tell you they are not used in Essential Tremor.

Nothing wrong with doing some web-searching on google, either.

Good luck!

--Boris

[Brookhaven]

A person doesn't shake except when trying to do something requiring fine motor control such as handwriting.

Sorry to hear your wife has it.

The statement quoted above is not correct. People with ET shake all the time. If you have a mild case, you may not notice it until you are doing something requiring fine motor skills.

I can remember any number of times when I was just talking to someone, and they would ask (out of the blue as far as I was concerned) "why are you shaking?" or "are you nevous about something?" or "are you going through drug withdrawls or something?"

[RichardW]

I would disagree with you. Parkinsons is noted with shaking all the time except when doing something requiring fine motor control. Then the shaking will stop. This is the reason a person with Parkinsons could be a surgeon. A person with ET would be very unlikely to do this. In some respects, Parkinsons is the mirror opposite of ET, but its prognosis is much more serious. I have viewed my wife over many years and she does not shake "all the time." As I said, Inderal can be of great help, but must be monitored as it can reduce heart rate. Reduction of stress can also be quite helpful.

[RichardW]

This is an area that I know a little bit about with both my wife and I have afib. Inderal is relatively innocuous but as stated can lower the heart rate significantly. I've never heard of it causing afib. Typically it would be prescribed in low dosages. Rates lower than 60bpm is defined as bradycardia. My wife was unable to use Sotalol (Betapace) because it is partly a beta-blocker so she was placed on Tabocor. I have been on Sotolol for the past two years and other than exacerbation of the sensation of cold have no significant side effects.

[RichardW]

BTW, tenormin (atenolol) and sotolol are different classes of drugs. Tenormin is typically used for blood pressure control and can lower the heart rate markedly. It is a beta blocker. Sotalol actually messes around with the electrical activity and is usually administered in a hospital setting as it can potentially cause a fatal arythmia. All of these classes of drugs have the potential for fatal arythmias. To my knowledge none of the plain old beta-blockers would be likely to do this although they have to be watched for bradycardia. Usually people are more affected in that they lose steam in carrying out their daily duties. As my doctor put it one time, it is like putting a brick under the gas pedal of your car.

Inderal is often prescribed for stage fright. It is a quick acting beta blocker and can be quite effective in lowering the heart rate when in atrial flutter, a cousin of atrial fibrillation. I know it as I have used it myself, successfully.

[Brookhaven]

Thanks for the post. I believe my step-daughter may have this condition, in a mild form, but still noticable, and to her, troubling.

I was diagnosed correctly as a child, but my parents basicly took the attitude that, since there was no cure, they should just ignore it. Unfortunatly, that put me into a lot of situations where I was not only had the normal worries of how I would do, but also worried about how others would percieve my tremor.

It is really best to have this in the open.

Apprehension tends to make ET worse, so your step-daughter is going to find that the times when she most wants to remain calm (like public speaking, or a job interview) her tremor will be at its worst. She won't be able to hide it. Her choice is to get it all out in the open, just isn't going to work.

The temporary treatment for ET is alcohol. For some reason, a drink or two will calm the tremor for a couple of hours. If she needs to do any presentations in school, or do any fine manipulations (I almost gave my shop teacher a heart attack when he saw me trying to use a table saw), a drink beforehand (even for a minor) is resonable if she needs it. This is one of the few cases where the old joke about only drinking for medicinal purposes is actually true.

It is a good idea to have a letter on file from her doctor with the school and any other relavent insitutions (like your church or police department) describing her conditon, and listing the times and amounts where her use of alcohol is considered medicinal. She should also carry a copy with her. I had an incident where a police officer gave me a hard time about having alcohol in a public place where it was prohibited, even though in that instance I was using it to treat my ET prior to appearing before a crowd.

[Brookhaven]

Her choice is to get it all out in the open, just isn't going to work.

Oops.

I meant her choice is to get it all out in the open, or just avoid situations where it is a problem. Trying to pretend it doesn't exist is not going to work.

[boris]

"I've never heard of it causing afib."

You have now. I had afib after inappropriately rapid withdrawl of Inderal. It is a most unforgiving drug.

--Boris

[boris]

"Sotalol actually messes around with the electrical activity and is usually administered in a hospital setting as it can potentially cause a fatal arythmia."

I am currently taking 400 mg of Sotalol daily outside the hospital. It controls my vagus-nerve-related Atrial Fibrillation. Also it helps to control my long-term problem with ideopathic sinus tachycardia.

BTW, 400 mg is beyond the recommended dosage--but that is the minimum dose that works on me.

--Boris

[NotAFeminist]

I was on a beta blocker for ET and while my tremor went away I didn't like the side effects. I cut caffine completely out of my diet and that has helped alot.

[PA Engineer]

This is considered a movement disorder and should be treated by a neurologist. For the best site on the web please check out We Move. For severe (last resort) essential tremor deep brain stimulation inplants are being successfully used. My wife is a neurologist and her specialty is movements disorders. Her patients range from very mild tremor to severe dystonic like symptoms. Many of the latter have left nursing care and returned to normal living after DBS surgery.

[RichardW]

That's an awful lot of Sotalol. The possibility of Torsades de Pointes increases with the dosage. I take 160mg daily. I think I would get a second or even third opinion and I would want to take a long look at my medical record. All you need to do is to ask for a copy. In particular what does your echo (I assume you have had one) show? What is your EF? Should be above 50%. You might be able to get rid of the meds altogether with an ablation or maze procedure. I think most afib (90%) comes from the pulmonary vein.

[boris]

"That's an awful lot of Sotalol. The possibility of Torsades de Pointes increases with the dosage. I take 160mg daily. I think I would get a second or even third opinion and I would want to take a long look at my medical record. All you need to do is to ask for a copy. In particular what does your echo (I assume you have had one) show? What is your EF? Should be above 50%. You might be able to get rid of the meds altogether with an ablation or maze procedure. I think most afib (90%) comes from the pulmonary vein."

My ex-cardiologist (now retired) recommended my current one. Supposedly the best on the West Coast. My old doc--a personal friend, told me, "See Dr. X. I won't let anyone else touch me." An ego bigger than the universe. Personally I loathe him. I won't mention his name. He has not advised ablation or the (still experimental?) maze.

I've had an electrophysiologist consulting too.

My afib--I firmly believe--is vagus-nerve related. Can't convince the Great Stone Face (cardiologist) but I am certain.

--Boris