Tags: essential | tremor | hand | shakes | treatments | Parkinsons | MRI

New Treatments Ease Essential Tremor

By    |   Monday, 02 June 2014 07:22 AM

If your hand shakes as you hold a beverage, jot down a note, or dial a phone, you may have essential tremor, a common neurological condition that causes an involuntary trembling of the hands.
Often confused with Parkinson’s disease, essential tremor is actually eight times more common and affects an estimated 10 million people in the U.S., according to the International Essential Tremor Foundation.

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Yet, despite how widespread it is, especially as people get older, it wasn’t taken all that seriously by the medical community until recently. It wasn’t until last year that essential tremor (ET) was classified as a specific disorder by the World Health Organization. This is an important breakthrough, experts say, because it can lead to improved research protocols and better clinical care for those with the condition.
After years of hit-or-miss drug therapies, new ground-breaking treatments are now becoming available.
Essential tremor affects men and women equally and is hereditary in more than 50 percent of cases. Though it is more commonly seen in older adults, ET can occur at any age and it is often progressive.
It most commonly affects the hands, but ET can cause shakiness in the legs and head, or cause a quavering voice. Although alarming, essential tremor is not life threatening.
Usually, the tremor that’s characteristic of ET occurs while performing a movement – such as eating, drinking, writing, typing, or brushing teeth. The severity can range from a barely noticeable shakiness that comes and goes with stress, anxiety, or fatigue to a severe tremor that makes it difficult to perform daily activities.
“It’s not known exactly how stress and fatigue worsen tremor but adrenaline that the body releases during times of stress may activate muscles and enhance the degree of tremor that’s already present,” explains Ludy Shih, M.D., assistant professor of neurology at Harvard Medical School and director of the movement disorders fellowship program at Beth Israel Deaconess Medical Center in Boston.
There aren’t any specific medical tests that are used to diagnose ET. Rather, a diagnosis is made on the basis of a detailed medical history and neurological evaluation that’s designed, in part, to rule out other causes of the tremor. 
If your tremor is mild and doesn’t bother you, it doesn’t have to be treated. But if it interferes with your ability to function, medications – such as beta blockers, anti-seizure drugs, and anti-anxiety meds – sometimes work. The problem is that they’re effective only about 50 percent of the time and often have serious side effects.    
Now, there are two newer options that appear promising.
One is something called MRI-guided gamma knife radiation treatment, which uses cobalt beams to deliver a precise dose of radiation to the thalamus, a tiny area of the brain that controls some involuntary movements.
One treatment of 40 to 90 minutes can cause the tremor to get better in days to weeks, says Edward Mullen, M.D., co-medical director of Long Island Gamma Knife at South Nassau Communities Hospital in Oceanside, N.Y. “Two-thirds to 75 percent of people with essential tremors clearly benefit from the treatment. The results are typically robust – and they last.”
A new MRI-guided high-intensity ultrasound technique is also showing success in treating ET. The technique uses concentrated ultrasound waves to “create selective damage to a part of the brain that may contribute to the cause of tremor,” said Dr. Shih.  Although this sounds scary, so far the treatment seems safe with few side effects reported.
In a recent study, doctors from the Toronto Western Hospital treated four people with chronic, medication-resistant essential tremor with MRI-guided focused ultrasound. They experienced immediate and sustained improvements in their hand tremor. While the therapy seems promising, it “needs to be further studied to determine how safe and effective it is,” Dr. Shih says.  

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The complete version of this article first appeared in Health Radar. To read more, CLICK HERE.

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If your hand shakes as you hold a beverage, jot down a note, or dial a phone, you may have essential tremor, a common neurological condition that causes an involuntary trembling of the hands. Often confused with Parkinson's disease, essential tremor is actually eight times...
essential, tremor, hand, shakes, treatments, Parkinsons, MRI, ultrasound, radiation
Monday, 02 June 2014 07:22 AM
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