Movement Disorders

Essential Tremor

Essential TremorWhat is essential tremor?

Essential tremor is a chronic neurological condition that presents as involuntary trembling in a part of the body. It occurs most often in the hands and arms, but may also affect the head, voice and legs. The tremor is often associated with purposeful movement, such as writing, buttoning clothes or holding a glass, or when the patient is maintaining a fixed position against gravity, such as when the arms are stretched out straight. The tremor is usually absent or minimal with rest and disappears during sleep.

What are the symptoms of essential tremor?

The symptoms of essential tremor may be socially embarrassing and may cause difficulty in performing fine motor tasks such as handwriting, eating, drinking and buttoning clothes.

Essential tremor may develop anytime from childhood to late adulthood, but the usual age of onset is 45 or after. It may occur randomly or be inherited as an autosomal dominant trait.  In inherited cases, children of affected individuals have a 50 percent risk of inheriting a gene for essential tremor and eventually developing the disease.

How is essential tremor diagnosed?

Evaluation of essential tremor includes a thorough history and physical.  Different assessments are performed including the anatomic distribution of the tremor, the amplitude and frequency of the tremor, muscle contraction period, degree of functional disability and other medical conditions and medications taken. Patients at the Stanford Comprehensive Movement Disorders Center will have a videotaped examination as well as a tremor rating scale and tremorography, where the amplitude and frequency of the tremor are measured.

How is essential tumor treated?

Medical treatments

Medical treatment includes the use of different medications such as:

Some patients may benefit from local injections of botulinum toxin (BTX) type A (Botox), which may help suppress the tremor.

Surgical treatments

Surgical treatment involves thalamic deep brain stimulation. This works especially well for limb tremors. During this procedure, electrodes are implanted in the ventral intermediate (VIM) nucleus of the thalamus, an area of the brain that is involved in motor control. The electrodes are connected via an extension to an implantable pulse generator which is placed under the skin near the patient's collarbone. Electrical signals delivered to the thalamus work to suppress the tremor. Patient's can usually come off or reduce their medications after this procedure.

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