“My husband has recently been diagnosed with Essential Tremor. He is in his 80s. Is this anything we need to worry about, and can we do anything to help his symptoms?” – Mary.
Thank you for your question Mary. This is a common problem in general practice, especially amongst older patients, and can cause considerable distress for sufferers.
“Tremor” is a general term, used to describe an involuntary, repetitive movement affecting a specific body part, most commonly the hands. Mild tremor is normal for everyone from time to time – this type of tremor is called “physiological tremor”. However, when tremor becomes more pronounced or persistent, it is worth checking with your doctor to work out exactly what is going on.
The most common cause of tremor in patients presenting for medical help is Essential Tremor (ET). It is more prevalent as we age, so most patients with this condition are over 40. However, some people who have a strong family history of ET will develop it much earlier, even in childhood. It usually starts in the arms or hands, but can progress to involve other parts of the body including the legs, head, jaw or face. It is often symmetrical.
The type of tremor that occurs with ET doesn’t tend to be present at rest, but comes on when the affected body part is held in a certain position, or with movement. ET is progressive, and eventually may persist all the time, causing significant disability and difficulty performing everyday tasks.
ET tends to worsen with stress, tiredness, hunger and very emotional situations. Interestingly, drinking small amounts of alcohol usually leads to an improvement in ET. ET often runs in families – a child will have a 50 per cent chance of developing ET later in life if they had a parent with the condition. However, it can occur “de novo” as well, with no prior history in the family at all.
It is important to differentiate ET from other types of tremor, so talking to your doctor is a good idea. He or she will suggest a referral to a neurologist for further testing if the diagnosis is in doubt. The other types of tremor that can mimic ET include:
* Thyroid disease
* Parkinson’s disease
* Kidney and liver disease
* Tremor related to medication, caffeine or alcohol
* Other movement or neurological disorders, such as dystonia or cerebellar syndrome.
If needed, a neurologist will do blood tests, special nerve conduction tests and perhaps imaging such as an MRI to ascertain exactly what is the underlying cause of the tremor. The presence or absence of other symptoms will assist in making the diagnosis – in ET the tremor will not be associated with other symptoms, but will occur in isolation.
Once a diagnosis of ET has been reached, it is important to understand that unfortunately it cannot be cured. Although it does tend to get worse with time, it will never become a “dangerous” health condition, or limit life expectancy in any way. There are also many good treatments available, with up to 8 out of every 10 sufferers reporting a really good response to their medication. The most common treatment options are:
* Propranolol – this drug is a beta-blocker, and is more commonly used to treat high blood pressure and heart disease. It can be highly effective at treating ET
* Primidone – this was originally a drug used in epilepsy, but again is used now for treating ET; if either of these 2 medications aren’t effective enough, they can be used in combination
* Other medications including topiramate and gabapentin can be trialled if the first two pptions fail
* Surgery – if the ET is very severe, and medication has failed, surgery may be considered
* Botulinum toxin – in cases where the tremor is confined to the head and neck, “Botox” injections can be a good solution; however they are generally not helpful for tremor of the hand or arm.
It is also perfectly acceptable to opt for no treatment at all. Some patients do this, preferring to optimise their lifestyle and eliminate those factors that may be exacerbating their tremor. However if your husband’s symptoms are severe, Mary, I suspect he may have been recommended some medication.