How can you tell the difference between essential tremor and Parkinson’s disease?
Essential tremor is a neurological disorder that causes tremors, generally of both hands, but also the head and voice. It is often confused with Parkinson’s disease, but the tremor in essential tremor is an action tremor, which means that the tremor is most noticeable when the limb is in use or moving (e.g. writing, eating, drinking a glass of water) and improves when the limb is at rest. This is opposite of the tremor seen in Parkinson’s disease, which is most noticeable when the limbs are relaxed and at rest, and lessens when the affected limb is in use.
Who is affected by essential tremor?
Up to 10 million Americans are estimated to have essential tremor; 10 times the number of people with Parkinson’s disease. ET affects males and females equally across a multiracial population. Individuals with a clear family history of tremor are at greater likelihood of developing ET. However, it can occur in individuals without a clear family history. While it can start at any age, onset is most common in middle age.
Can my children get essential tremor?
Children of individuals with ET have a greater likelihood of having the condition, although some may never experience symptoms. A variant in the gene LINGO1 has been identified as a risk gene, although not all individuals with ET carry this variant—which can also be present in people without ET. For those affected, the areas impacted and severity of symptoms can vary from person to person.
Does essential tremor get worse over time?
Typically, ET symptoms gradually worsen over time. While most people with ET only experience mild to moderate symptoms as they age, others may experience substantial disability. As it progresses, tremor frequency (number of repetitions per second) may decrease; however, tremor amplitude (magnitude/strength) may increase, which can cause challenges with fine, discrete motor skills such as writing or eating. With treatment, symptoms can be managed.
What medications are typically prescribed to treat essential tremor?
There are several medications available to help manage ET symptoms. It is important to work with your doctor to find a medication that is right for you. In addition, it is equally important to make sure that a high enough dose of medication is taken for it to be effective. Provided below is a list of common medications used for ET with upper limits of the dose by which we would expect an effect on tremor. If your physician has not prescribed doses of these medications similar to the ones listed, you may consider going back to your physician to try higher doses before considering other treatment options, such as deep brain stimulation.
Doses of Essential Tremor Medications:
- Primidone - Up to 350 milligrams daily
- Propranolol - Up to 320 milligrams daily
- Topiramate - Up to 400 milligrams daily
- Clonazepam - Up to 6 milligrams daily
- Gabapentin - Up to 2700 milligrams daily
- Mirtazepine - Up to 45 milligrams daily
Are there surgical options for essential tremor?
Deep brain stimulation (DBS) is a therapeutic option for those with severe disabling ET not already managed by medications. DBS is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. It is primarily utilized for patients who have Parkinson’s disease, dystonia, or essential tremor, who can’t adequately control their disease with medication.
Thalamotomy, involving the destruction of tremor producing cells in the brain region called the thalamus, is another surgical option. Using a small temperature-controlled electrode, a permanent lesion is created in the thalamus that helps to stop tremor without disrupting sensory or motor control.
Talk to your doctor about surgical and non-surgical options that are right for you.
Are there ways to treat essential tremor without medications?
Some patients may benefit from the Liftware device, which helps patients to eat with less spillage. This device comes with a stabilizing handle and a utensil attachment and works by stabilizing the utensil so that less food is spilled. Stress management and physical therapy are helpful for those with mild to moderate ET, but are typically used in combination with medications and/or surgery. For those with symptoms not controlled satisfactorily by medications, deep brain stimulation (DBS) or thalamotomy can be helpful in improving symptoms and may even help to reduce the amount of medications needed to improve symptoms. Your neurologist will be able to help you determine options that are right for you.
Is head tremor the same as essential tremor?
Head tremor is often described as an oscillation of the head, causing it to move side to side or up and down. The tremor can be rhythmic like a pendulum or irregular and more pronounced. While head tremors can be one of many types of tremors experienced by those with essential tremor, they are also seen in patients with dystonia.
Can something be done about voice tremor?
Botulinum toxin injections are generally the most effective treatment for voice tremor. Deep brain stimulation (DBS) using bilateral stimulation (typically reserved for those with Parkinson’s disease or dystonia) may also help voice tremors, but will often cause slurred speech as well. For those with essential tremor, DBS is most often placed unilaterally (on one side of the brain), at least initially.
Sources:
Chou, K, Grube, S, Patil, P. Deep Brain Stimulation. A New Life for People with Parkinson’s Dystonia, and Essential Tremor. New York: Demos Medical Publishing, 2012.
International Essential Tremor Foundation. (2010). ET vs. Parkinson’s: How do they differ? Retrieved January 15, 2015, from http://www.essentialtremor.org/wp-content/uploads/2013/07/ETvsPD092012.pdf National Institute of Neurological Disorders and Stroke. (July 24, 2014). Tremor Fact Sheet. My head shakes: is it dystonia? (2014).