The Essential Tremor: Causes And Symptoms

A tremor in the upper and lower limbs can indicate various diseases. This includes, for example, the so-called essential tremor. In this article we explain what this disorder is all about.

The essential tremor: causes and symptoms

Tremors in the upper and lower limbs can indicate various medical conditions. This includes, for example, the so-called essential tremor. In this article we explain what this disorder is all about.

The essential tremor is widely used in general. It occurs most frequently among the movement disorders – even before Parkinson’s. According to statistics, its occurrence in adults is 20 times more likely than Parkinson’s disease.

People over 65 are most severely affected. However, it is assumed that the first symptoms can appear between the ages of 40 and 60. Such cases have also been recorded in children.

The essential tremor is characterized by uncontrolled movements in the form of persistent twitching. This is especially true for the upper limbs, i.e. arms and hands. It is also typical that the episodes run symmetrically and with pauses.

While this is a chronic disorder that worsens over time, it is not present for the entire day and sometimes for a few days.

Essential tremor is not fatal and is not associated with either cognitive decline or degeneration of the nervous system. Even if it is considered to be benign, it is a nuisance for those affected. Daily activities such as writing, holding a cup or tying shoes cannot be carried out.

The essential tremor: causes

There are currently insufficient studies to determine a clear cause of the disorder. This is because this is benign and is interrupted by breaks.

However, it is known to result from a change in the connections in the nervous system that are associated with the musculoskeletal system. The thalamus, the nigrostriatal pathway and the cerebellum are areas of the nervous system that are responsible for the movement processes.

The scientific hypothesis here is that one of these areas undergoes an abnormal change in the case of essential tremor, which can result in the involuntary movements.

The essential tremor: causes

Cases in which both the parents and their children suffered from essential tremor prove that this change is related to a genetic cause. For this reason, the disorder is often referred to as familial tremor.

The essential tremor: symptoms

To determine the symptoms, essential tremor must first be distinguished from Parkinson’s disease. In the former, the involuntary twitching occurs when the person concerned wants to perform a certain movement or tries to maintain a certain posture. With Parkinson’s, these occur in a resting state.

In addition to the most noticeable sign that the upper limbs in particular are affected, the following symptoms may also occur:

  • Altered voice: Essential tremor can affect the larynx by altering the way the vocal cords produce voice .
  • Nodding and shaking the head:  The person concerned nods or shakes their head, but this involuntarily.
  • Difficulty performing everyday activities: Sometimes the essential tremor is not particularly noticeable. However, it is difficult for the respective person to grasp something, to use an object or to write.

If left untreated, symptoms may worsen with age. It has been found that these are more common with high caffeine consumption. This also applies to stress or poor sleep.

It has been shown that small amounts of alcohol can improve symptoms. However, this is not a general recommendation.

The essential tremor: causes

Treatment options

The essential tremor cannot be cured. According to the hygienic-dietary method, caffeine should be avoided. In the case of stress, it is advisable to resort to psychotherapy or sleeping pills, for example.

Some patients gain improvement through what is known as kinesiotherapy or physiotherapy, which aims to improve muscle control and control balance.

Should medication be administered, the following should be mentioned, which are frequently used and have proven beneficial:

  • Propanolol: This is a beta blocker, possibly the most effective for reducing symptoms. It should be used with caution in patients with heart disease; especially if it is pre-loaded with clogged vessels. The administration therefore always requires observation by the attending physician.
  • Primidon: Primidon is an anticonvulsant.
  • Antidepressants: These can be effective against underlying stress.
  • Anxiolytics:  They are used to cope with stress and regulate sleep.
  • Botulinum toxin: Botulinum toxin is given as an injection into certain parts of the body, mainly the head and hands.

If these drugs are not effective, more complex treatments are used. These are intended for patients who have little response to the aforementioned drugs and who have an invalid clinical picture. Such therapeutic measures include:

  • Stereotactic radiotherapy: With the help of precise radiation therapy, a specific area of ​​the nervous system is treated.
  • High Intensity Focused Ultrasound (HIFU):  This application is the same as the previous one. However, an ultrasound is used here.
  • Implant of a stimulator: A device is placed that sends electrical stimuli to the thalamus.
  • Thalamotomy:  The thalamotomy means the surgical detachment of parts of the thalamus. Nowadays, this traditional procedure is being replaced by radiosurgery or HIFU.

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