Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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The first line pharmacotherapy for Essential Tremor aims to dampen the central oscillator. Beta blockers (specifically Propranolol) are the standard of care. They block the peripheral beta adrenergic receptors in the muscle spindles and have central effects. They are particularly effective for hand tremor but less so for head or voice tremor.
Primidone is an anti epileptic drug that is metabolized into phenobarbital. It is highly effective for ET but requires careful titration due to sedation. For patients who fail these, second line agents include Gabapentin, Topiramate, or Benzodiazepines (like Clonazepam), though the latter carries risks of dependence and sedation in the elderly.
Treating Parkinsonian tremor involves restoring the dopamine balance in the basal ganglia. Levodopa is the most effective agent, though tremor can sometimes be “Levodopa resistant” compared to rigidity or slowness. Dopamine agonists are also used, particularly in younger patients.
Anticholinergics (like Trihexyphenidyl) are specifically effective for the resting tremor of Parkinson’s. They work by rebalancing the acetylcholine dopamine ratio in the striatum. However, their use is limited in older adults due to cognitive side effects, such as confusion and memory loss.
Deep Brain Stimulation is the surgical gold standard for severe, medication refractory tremor. For Essential Tremor, the target is the Ventral Intermediate Nucleus (Vim) of the thalamus. High frequency electrical stimulation in this area effectively “jams” the abnormal oscillatory network, silencing the tremor instantly.
For Parkinson’s disease, the target is often the Subthalamic Nucleus (STN) or Globus Pallidus (GPi), which treats tremor along with rigidity and bradykinesia. DBS is adjustable and reversible. It allows patients who could not feed themselves to regain complete independence.
A revolutionary non invasive option is Magnetic Resonance guided Focused Ultrasound (MRgFUS). This incisionless procedure uses over 1,000 ultrasound beams focused on a single point in the thalamus (Vim). The converging energy creates a thermal ablation (lesion), destroying the cells responsible for the tremor.
It is currently approved primarily for unilateral treatment (one side). It offers an option for patients who are not candidates for open brain surgery (DBS). The effect is immediate and permanent. However, unlike DBS, it is not adjustable, so precision during the procedure is paramount.
Pharmacology and surgery are not the only answers. Occupational Therapy plays a vital role in functional adaptation. Weighted utensils can dampen the amplitude of the tremor by changing the resonant frequency of the limb. “Liftware” are stabilizing spoons that counteract the tremor movement electronically.
Physical therapy focuses on proximal stability and core strength, which can help control distal tremor. For functional tremor, rehabilitation involves “retraining” the brain using distraction techniques and motor learning to break the abnormal entrainment patterns.
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DBS is not a cure for the underlying disease (like Parkinson’s), but it is a highly effective symptomatic treatment that can suppress the tremor by 80-90% while the device is on.
It is generally safe and non invasive (no cutting), but because it creates a permanent lesion in the brain, there are risks of side effects like balance issues or sensory numbness if the target is slightly off.
Beta blockers lower your heart rate and blood pressure, which can lead to fatigue or exercise intolerance as a common side effect.
Many patients can significantly reduce their medication after DBS or Focused Ultrasound, but some may still need lower doses to control other symptoms or residual tremor.
These are heavier than normal forks or spoons; the extra weight makes it harder for the fine tremor movements to shake the utensil, effectively “dampening” the shaking so food stays on.
essential tremor About 10 million people in the United States deal with uncontrollable shaking, often in their hands. This is called essential tremor. It makes
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