Neurology-Online

Is Essential Tremor Curable?

introduction

The tremor in itself is not a disease but a neurological symptom that can best be translated as "tremors". The causes of a tremor range from harmless things such as excitement (so-called physiological tremor) to medication and severe movement disorders such as Parkinson's tremor. A particular tremor is essential tremor, a movement disorder with a previously unexplained cause. This is what is known as an action tremor, which occurs primarily during everyday actions such as pouring water or eating and, depending on its severity, can have a massive impact on those affected. Even if the underlying mechanisms are not sufficiently understood, there are promising therapeutic approaches.

Here you will find a general overview of the topic tremor

Is Essential Tremor Curable?

So far it is known that the essential tremor occurs in families and that it is mostly based on certain mutations. However, the exact mechanisms that lead to the disease are still not sufficiently understood, so that targeted therapy is not possible. The essential tremor is therefore not curable. However, there are some therapeutic approaches that can provide good tremor relief.
First of all, it should be determined whether there really is an essential tremor. Characteristics are

an action tremor, i.e. a tremor during activities such as restricting water
usually tremor of the hands and head, occasionally also a so-called voice tremor
familial accumulation
Increase in tremor with stress or psychological stress
An improvement is often observed with alcohol (which of course does not constitute an invitation to drink alcohol!)

Furthermore, other causes, in particular tremor from medication, must be ruled out. These include primarily thyroxine, lithium, cortisone and valproate. Caffeine can also trigger a tremor, in which case drinks containing caffeine should of course be reduced.

Once the essential tremor is diagnosed, the degree of impairment is important. If there is no or only moderate impairment in everyday life, therapy is often not necessary. Otherwise medication can help, and in severe cases surgical implantation of a “brain pacemaker” may be necessary.

Find out more about the causes and diagnosis of the essential tremor

OP for essential tremor - the deep brain stimulator

What can surgery bring?

The operation for essential tremor is the implantation of the deep brain stimulator (DBS), a device often referred to as a “brain pacemaker”, as it is perhaps known from the therapy of Parkinson's disease. It involves the implantation of an electrode in a region of the brain - the Nucleus ventralis intermedius thalami (Vim) - by means of a complex neurosurgical operation. The exact mechanisms are very complex and also not yet fully understood, ultimately there is a modulation of the Vim, which plays an important role in the development of the essential tremor and belongs to the so-called tremor network.

The lead is then wired under the skin to a small device that is implanted under the collarbone, similar to a pacemaker. The THS can also be readjusted at any time later using a magnet. Of course, this operation should only be carried out by designated specialist centers.

The implantation of a DBS is a comparatively safe operation, but nevertheless it is an operation on the brain and involves certain risks. Therefore, it should only be used in the case of severe symptoms, when drug therapy has failed despite sufficient dosage.

In these cases, however, the operation is very successful. Symptoms have been improved by up to 80%, so that very severely affected patients can often be able to lead a “normal” life again.

Risks of the operation

Of course, like any other operation, implantation also has risks. These include the general risks of an operation such as secondary bleeding, cerebral hemorrhage, damage to nerves and vessels, damage to surrounding structures, especially brain damage and of course the risks of anesthesia. The wound can also become infected. Another risk is always failure of the measure.

Overall, however, the risks associated with DBS implantation are to be classified as rather low, as each step is planned very carefully beforehand by a team of specialists. If the implantation of a brain stimulator is an option for you, your neurosurgeon will explain all of the individual risks in detail.

Essential tremor medication

Beta blockers

When treating essential tremor, the severity of the symptoms and the impairment in everyday life must first be taken into account. Some patients have only a slight tremor under tension. If there is no or only moderate impairment as a result, therapy is often not necessary. Otherwise you can try to be treated with medication. For this purpose, beta blockers are primarily used in patients under the age of 60; propranolol in particular has proven itself. Other so-called non-heart-specific (cardioselective) Beta blockers can be used. The neurologist's job is to set the dose so that the best possible effect is achieved with as few side effects as possible. In the case of therapy failure or patients over 60 years of age, the anti-epileptic primidone is primarily used. 01

Primidon

Primidone is the drug of choice for patients over 60 years of age, while beta blockers are usually the second choice. Primidon originally comes from the therapy of epilepsy, but is also used for essential tremor. Primidone can also be used in patients under 60 if beta blockers such as propranolol are not sufficiently effective. If both drugs are inadequate, they can also be combined.

Benzodiazepines

Benzodiazepines are very strong sedatives and sleeping pills that are subject to the Narcotics Act in Germany. In principle, their use should be carefully considered, as they can have dangerous side effects and become addictive very quickly. Therefore, they should only be used when really necessary and then only for a short time.

Benzodiazepines are not effective for essential tremor and should not be used here according to the guidelines of the German Society for Neurology!

Find out more about the uses and side effects of the Benzodiazepines

What else can you do to make the tremor better?

If neither propranolol nor primidone nor the combination of the two are sufficiently effective in the case of strong symptoms, treatment with gabapentin or topiramate can be tried next. Both drugs originally come from the therapy of epilepsy, but are also used for other diseases and symptoms, gabapentin, for example, for neuropathic pain. Only if the desired effect is not achieved here either, the use of a deep brain stimulator can be considered. If this cannot be used due to contraindications or if the operation is refused by the patient, highly effective reserve medication is still available, which your neurologist can inform you about if necessary. These include, for example, the neuroleptic clozapine or the sedative phenobarbital.

In particular, when the essential tremor affects the head or the voice, medication and deep brain stimulation are often less effective. It is controversial whether the use of botulinum toxin (“Botox”) is suitable for therapy. It is best to ask your treating neurologist.

Since essential tremor is often aggravated by emotional strain and stress, it should be avoided if possible.Relaxation methods such as progressive muscle relaxation or autogenic training can also help.

Even if the essential tremor often improves after alcohol consumption, it is due to the side effects of alcohol such as addiction, organ damage and much more. Of course, we advise against consuming alcohol regularly!

Further information

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