Does your hand shake uncontrollably when you raise your arm in the air? Do you struggle to write letters with how your hand tremors? Do the tremors make you reconsider doing activities in public?
If you answer yes to any of these questions, it is likely you are dealing with an essential tremor. Essential tremors are one of the most common neuromuscular disorders. Although the cause of this condition is unclear, many studies suggest genetics and neurodegeneration of the cerebellum are the primary culprits. Essential tremors can significantly impact one’s ability to perform tasks due to the impaired control of their extremities. This includes using knives when preparing a meal, holding utensils when in a restaurant, or even writing with a pen. Sometimes, the disorder is so debilitating that it may cause people to reconsider going out with their family and friends in fear of embarrassment. Fortunately, there are treatments which can help alleviate the symptoms, allowing people to regain control of their life once again.
Essential Tremors or Parkinson’s Disease?
Before we talk about the management of essential tremors, it’s important to differentiate the disorder from Parkinson’s disease. Although both are considered neuromuscular disorders, each condition will have unique characteristics.1
|Essential Tremor||Parkinson’s Disease|
|Type & Onset||Higher frequency tremors which occur mostly during activities.||Lower frequency tremors which occurs during rest.|
|Family History||In most patients (>50%)||Rare (10%)|
|Common Age Groups||Middle age individuals||Age of onset is 55-65 years old|
|Affected Region||Bilateral (both arms) tremor of the hands. May also affect the head and voice.||Unilateral (one arm) tremor which could progress to the other arm over time.|
PD patients are likely to struggle with walking (slowness, rigid, imbalance).
|Alcohol*||May improve essential tremors.||No effect on Parkinson’s disease.|
Identifying the difference between the two disorders is vital in selecting treatment and its future success. Each condition has different ways of managing the symptoms. By knowing which condition you are working with, your team will able to tailor care to suit your needs.
Treatments of Essential Tremor
Although there are currently no cures to essential tremor, there are several strategies available to help manage the symptoms.
- Reducing Aggravating Triggers: Agents such as stimulants and caffeine can worsen the tremors. Minimizing exposure to these agents can help reduce the severity of symptoms.
- Occupational and Physiotherapy: Occupational and physiotherapists collaborate with their patients to find strategies for reducing symptoms. In events where this cannot be achieved, these clinicians will develop plans for you to work around the tremors.
- Alcohol*: There have been numerous reports of alcohol reducing the amplitude (height of tremor) of their symptoms. However, these effects are short-lived and may result in rebound tremors once the alcohol wears off. Therefore, treatment with alcohol is usually not recommended by clinicians.
- Medications: Medical treatments are often initiated when the patient’s tremors affect their ability to undergo daily task. Agents are chosen based on the patient’s needs, the severity of the tremor, and side effect profile of each drug. Common agents patients may be prescribed are propranolol or primidone. The course of one treatment can take several months. Thus it is imperative that patients collaborate with their team to identify if changes (e.g. doses) are necessary to optimize their care.
- Surgery: Depending on the severity of the tremor, clinicians may advise patients to seek surgical treatment. Your team will discuss the risk, benefits and additional information you may need to know to make an informed decision regarding surgical procedures.
Regardless of what approach you may seek, the most important thing you can do is to collaborate with your healthcare team. Providing your stories and experience will help clinicians better understand what you are going through. In return, they can work together to optimize your therapy to improve your quality of life.
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- ET vs Parkinson’s disease How do they differ? [Internet]. Essential Tremor Toronto. 2018 [cited 19 December 2018]. Available from: https://essentialtremor.org/wp-content/uploads/2013/07/ETvsPD092012.pdf
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