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19 March, 2010

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Essential tremor

Essential tremor is a neurological disorder which causes involuntary shaking or trembling of particular parts of the body, usually the head and hands. Sometimes the voice is affected and sounds quavery. The tremors typically worsen when the hands are being used (kinetic tremor), and reduce significantly or stop altogether when the hands are resting. For some people, the condition worsens if they hold their bodies in certain positions (postural tremor). Generally, essential tremor gradually gets worse with advancing age. The cause is unknown and there is no cure, although drugs and surgery may help. It is thought that around six in every 100,000 people are affected by this condition. Older people are most susceptible, but anyone of any age can develop essential tremor - a person can even be born with it. Essential tremor and Parkinson's disease are different disorders.

Symptoms
The symptoms of essential tremor include:

Voluntary muscles are affected.
The hands, head and voice are most commonly affected.
Head nodding, if the head is affected.
Shaky, quivering voice - if the voice box (larynx) is affected.
The tremor is usually mild, rhythmic and fast.
The tremor is exacerbated by activity or movement.
The tremor eases when the body part is at rest.
The tremor stops when the person is asleep.
The condition worsens with age.
Other body parts that may become affected, in time, include the arms and eyelids.
The legs are rarely involved.

Essential tremor is not a form of Parkinson's disease
Essential tremor and Parkinson's disease are different disorders. Whereas essential tremor is characterised by shaking during movement, the symptoms of Parkinson's disease include involuntary shaking at rest, muscle stiffness and freezing. Parkinson's disease is caused by a deficiency of the brain chemical dopamine, which is necessary for smooth and controlled muscular movement.

The cause is unknown
Essential tremor is the most common type of tremor, and affects more people than Parkinson's disease. Some estimates suggest that around one in five people over the age of 65 years are affected. There is no known cause, but a genetic link is strongly suspected. Each child of a person with essential tremor has a 50 per cent chance of inheriting the disorder themselves. If a person with essential tremor has other affected family members, then the disorder is called 'familial tremor'.

Factors that worsen the tremors
Certain factors are known to worsen the condition, including:

Emotional stress
Caffeinated drinks
Alcohol
Insufficient sleep.

Quality of life may be affected
Uncontrollable shaking can reduce a person's quality of life in many ways, including:

Difficulties with everyday activities, such as writing, getting dressed or eating.
Irritation and stress caused by the inability to control the affected body part.
Social embarrassment.

Diagnosis methods
Essential tremor is diagnosed using a number of tests, including:

Medical history.
Physical examination.
Electromyography (EMG) test to check the electrical activity of muscles.
Tests to rule out other causes - such as x-rays, blood tests, magnetic resonance imaging (MRI) and computed tomography (CT) scans.

Treatment options
There is no cure for essential tremor. Treatment aims to suppress the involuntary movements, and can include:

Avoidance of known triggers, such as alcohol or caffeine.
Stress management.
Some drugs used to treat other medical conditions - such as heart disease (beta blockers) and epilepsy (anticonvulsants) - can help in some cases.
Other drugs, including tranquillisers.
Researchers are currently trialling the use of a 'brain pacemaker', a surgically implanted device that helps to regulate brain waves.
Brain surgery has enjoyed some success.
If the tremor is mild and doesn't stop the person from performing their usual activities, the only treatment may be regular monitoring and observation.
In some cases, alcohol can actually reduce the tremors. However, this isn't recommended as a treatment, since overconsumption of alcohol carries health risks.

Where to get help

Your doctor
Neurologist
Parkinson's Victoria Tel. (03) 9551 1122 or 1800 644 189

Things to remember
Essential tremor is a neurological disorder characterised by the involuntary shaking or trembling of particular parts of the body, usually the head and hands.
The tremors typically worsen when the hands are being used (kinetic tremor), and reduce significantly or stop altogether when the hands are resting.
The cause is unknown, although a genetic link is strongly suspected.
There is no cure.
Treatment aims to suppress the tremors and includes drugs, surgery and stress management. You might also be interested in:
Parkinson's disease.

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