Summary about Disease
Benign essential tremor (ET) is a neurological disorder that causes involuntary rhythmic shaking. It most commonly affects the hands, but can also affect the head, voice, legs, or trunk. It is called "essential" because the tremor is not caused by another condition, although genetics are thought to play a role. The term "benign" can be misleading as it indicates a lack of life-threatening nature, but the tremor can significantly impact daily activities and quality of life.
Symptoms
Rhythmic shaking, usually occurring when trying to use the affected body part (action tremor).
Most commonly affects the hands and arms.
Head tremor (nodding or shaking "no").
Voice tremor (shaky voice).
Less commonly affects the legs or trunk.
Tremor may worsen with stress, fatigue, or caffeine.
Difficulty with fine motor skills (writing, using utensils).
Tremor may initially be intermittent but can become more constant over time.
Causes
The exact cause of essential tremor is unknown. It's believed to involve the cerebellum and other areas of the brain that control movement. Genetic factors are thought to play a significant role, with about half of people with ET having a family history of the condition. Certain genes have been identified as possible contributors, but no single gene is responsible.
Medicine Used
Beta-blockers: Propranolol is commonly used to reduce tremor severity.
Primidone: An anticonvulsant medication that can be effective.
Topiramate: Another anticonvulsant sometimes used.
Gabapentin: Can be used for tremor control
Benzodiazepines: Such as clonazepam or alprazolam, may be used in some cases.
OnabotulinumtoxinA (Botox): Injections can be used for hand or head tremor.
Deep Brain Stimulation (DBS): A surgical option for severe cases where medications are not effective. Involves implanting electrodes in the brain to regulate nerve signals.
Focused Ultrasound (FUS): A non-invasive procedure that uses focused ultrasound waves to target and destroy a small area of the thalamus responsible for the tremor.
Is Communicable
No, benign essential tremor is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent essential tremor, as the cause is largely unknown. However, individuals with ET can take the following steps to manage their symptoms and improve their quality of life:
Reduce caffeine and alcohol intake: These substances can worsen tremors in some people.
Manage stress: Stress can exacerbate tremors. Relaxation techniques like meditation or yoga may be helpful.
Use adaptive devices: Utensils with larger handles, weighted pens, or voice-activated technology can make daily tasks easier.
Occupational therapy: An occupational therapist can provide strategies and assistive devices to help with daily activities.
Get adequate sleep: Fatigue can worsen tremors.
Consult with a doctor: Regular follow-up with a neurologist is important to monitor the condition and adjust treatment as needed.
How long does an outbreak last?
Essential tremor is not an "outbreak" type of disease. It is a chronic, progressive condition. The tremor may be intermittent initially, but it tends to become more constant and potentially worsen over time. There are no distinct "outbreaks" with periods of remission.
How is it diagnosed?
Diagnosis of essential tremor is primarily clinical, based on a neurological examination and medical history. There is no specific diagnostic test.
Neurological exam: The doctor will assess the tremor's characteristics (type, frequency, location, and severity). They will also evaluate other neurological functions, such as balance, coordination, and reflexes, to rule out other conditions.
Medical history: The doctor will ask about family history of tremor, other medical conditions, and medications, as some medications can cause tremors.
Ruling out other conditions: Blood tests may be ordered to rule out thyroid problems, metabolic disorders, or other conditions that can cause tremor.
Imaging (MRI or CT scan): Brain imaging is usually not necessary but may be performed to rule out structural problems in the brain.
Essential Tremor Rating Scale (ETRS): A standardized assessment tool used to evaluate the severity of tremor and its impact on daily activities.
Timeline of Symptoms
The timeline of symptoms can vary greatly from person to person.
Onset: The tremor can start at any age, but it's most common in middle age or later.
Initial stages: The tremor may be mild and intermittent, only noticeable during certain activities or when stressed.
Progression: Over time, the tremor may become more frequent, severe, and affect more body parts. The rate of progression varies widely.
Plateau: Some individuals may experience a period where the tremor remains relatively stable for several years.
Late stages: In advanced cases, the tremor can significantly interfere with daily activities and independence.
Important Considerations
Misdiagnosis: Essential tremor can sometimes be mistaken for Parkinson's disease. It's important to seek evaluation from a neurologist experienced in movement disorders to ensure accurate diagnosis.
Impact on quality of life: The tremor can significantly impact daily activities, employment, and social interactions.
Psychological impact: ET can lead to anxiety, depression, and social isolation. Mental health support may be beneficial.
Medication side effects: Medications used to treat ET can have side effects that need to be carefully monitored.
Individualized treatment: Treatment for ET should be tailored to the individual's symptoms, severity, and preferences.
Ongoing research: Research is ongoing to better understand the causes of ET and develop more effective treatments.