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Essential Tremor

The Essential Tremor is a type of tremor that occurs isolated and not as a symptom of a disease. The Essential Tremor is the most common movement disorder in the world. Essential Tremor often manifests in the upper extremities, especially in the hands; it can also manifest in the head, the tongue or the legs but this is not as common as the tremor in the hands. The shaking of the Essential Tremor is, in contrast to the Parkinsonian tremor, most of the time not in rest position but if a movement is intended. Another form of the Essential Tremor is the postural tremor; the shaking starts if patients hold objects. The Essential Tremor can occur at all ages; about 0,9% of the Austrian population suffers from Essential Tremor1. Within the age group over 65 years are 4,6% suffering from this tremor type2. This means that the disease occurs twice times more often than the Parkinson’s Disease.


Causes of Essential Tremor

The cause of Essential Tremor is not known. It is assumed that the nerve cells in the cerebellum change and cause the tremor. A genetic cause is also possible; children of patients diagnosed with Essential Tremor have a 50% risk to develop this movement disorder. Essential Tremor is not curable but can be treated with medications.

The tremor often starts in one side of the body, in later states of the disease the tremor starts to affect the other side of the body as well.


Treatment of Essential Tremor

Essential Tremor is often treated with beta blockers. Beta blockers are a group of substances that are commonly used to treat high blood pressure. Due to the intake of beta blockers the shaking calms and daily activities become much easier for patients. Another possibility is the intake of medication that are used in case of epilepsy; but every medication can have side effects like fatigue.

When the Essential Tremor reaches a level where medication has no effect anymore patients can get the treatment of deep brain stimulation. In this surgical procedure tiny electrodes are inserted into the areas of the brain, where the tremor has its origin. The so-called deep brain stimulator is implanted under the skin near the chest and is wired with these electrodes. The functioning is similar to the one of a pacemaker: the brain stimulator emits impulses to the thalamus. This brain area is responsible for the involuntary management of arbitrary movements; the thalamus is also responsible for the overactivity of the muscles – this overactivity then manifests as tremor. The individual medication and therapy of a patient always needs to be discussed with the attending doctor.

 

1Louis ED. Clinical Practice. Essential tremor. N Engl J Med 2001;345:887-91
2siehe FN 1



 

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