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Essential Tremor: Kinetic Tremor Causes, Symptoms, and Treatment

Essential Tremor is also known as a Kinetic Tremor or Benign Essential Tremor. It is a neurological disorder characterised by involuntary, uncontrollable shaking in any part of the body. It is the most common type of tremor disorder which often affects hands and forearms. The other parts of the body which might be affected are head, face, tongue, neck and torso. It rarely affects the lower body.

Essential tremors occur at any age, but it is more common in people who are above 40 years of age. It is not a life-threatening condition, but over a period of time, it may get worse leading to disability.

Essential Tremor - Neurological DisorderWhat are the Symptoms of Essential Tremor?

Essential tremors are characterised by small, rapid movements. The frequency of tremors varies in individuals; tremors can be experiencedcontinuously, frequently or occasionally. Essential tremors symptoms include:

  • Shaky voice
  • Nodding head
  • Twitching in face
  • Balance problems

What Factors Aggravate the Symptoms of Essential Tremor?

It has been observed that few factors trigger the onset of essential tremors. It is important to be aware of these factors and keeping them on check to avoid essential tremors as much as possible. These factors include:

  • Fever
  • Fatigue
  • Hunger
  • Smoking
  • Caffeine
  • Emotional stress
  • Extreme temperatures
  • Decreased blood sugar levels

What are the Causes of Essential Tremor?

Research has not revealedanyabsolute genetic cause, environmental causes or cellular defect that can lead to essential tremors. The possible factors that may contribute to essential tremor are as follows:

  • Genetics: If a parent has essential tremor, then the child has 50 % chances of getting it.
  • Other Medical Conditions: In few cases, essential tremor is a symptom of other nervous system disorders like Parkinson disease or dystonia.

Which Factors Increases the Risk for Essential Tremor?

Presence of risk factors increases the probability of essential tremors. However, an absence of risk factors does not guarantee that an individual will not get essential tremors. The following risk factors are associated with essential tremor:

  • Family History: Essential tremor is an autosomal dominant disorder; a defective gene in one patient is enough to pass the disease to the child. A child has 50 % chances of getting essential tremor if either of his/her their parent has it.
  • Age: Essential tremor is more commonly seen in individuals who are above 40 years of age.

What are the Complications of Essential Tremor?

In the initial stage, essential tremor is manageable. When it worsens over a period of time, it makes it difficultfor an individual to perform the daily activities. The various complications that an individual might experience include:

  • Depression
  • Unclear speech
  • Abnormal walking style
  • Social anxiety and embarrassment
  • Muscle movement lack voluntary coordination
  • Inability to perform daily activities like holding a cup, writing, tying the shoe lace

How is Essential Tremor Diagnosed?

No specific test is available for the diagnosis of essential tremors. Diagnosis of essential tremors is done by ruling out other possible conditions that may cause essential tremors and by doing a physical examination. Diagnosis steps include:

Review of medical history and family history:

Review of family history is done to determine if the essential tremor is due to genetic involvement. Medical history is reviewed to find out if any pre-existing condition is the causing tremors.

Tests for ruling out other conditions:

  • Blood and urine test: Blood and urine test is done to rule out thyroid disease, metabolic problems, alcohol abuse, drug side effect etc.
  • Neurological examination: In the neurological examination, the functioning of the nervous system is studied by checking tendon reflexes, determining the strength and tone of the muscle, ability to perceive sensation, posture and coordination and gait. This is done to rule out Parkinson’s disease.

Assessment of functional impairment:

This is done to determine the severity of essential tremor. In this assessment, the physician asks the individual to perform daily activities like drinking from a glass, brushing hair and the physician might ask to draw a spiral, or write etc.

How is Essential Tremor Treated?

Essential tremor cannot be cured. Treatment is given to control the progress of the disease and symptoms. In mild cases, treatment is not required but it becomes essential when the condition is severe. The treatment includes:

Medication:

The medications for treating essential tremors include beta-blockers, anti-convulsion drugs, and tranquilizers. Beta-blockers act by limiting adrenaline levels it helps in controlling tremors. Anti-convulsion medications act by reducing excitability of the neurons. Botox injections are also used for treating essential tremors; they can control tremors for up to 3 months.

Surgery:

Surgery is done when symptoms are not improved through other treatment options. The surgical procedures include:

  • Deep Brain Stimulation: This surgery is done when the tremors are very severe and are not responding to medication. In this procedure, electrodes are inserted in the thalamus, the portion of the brain that controls movements. A neurostimulator is implanted in the chest. The electrode and the neurostimulator are connected by a probe. The neurostimulator interrupts the signals, which cause tremors, from reaching the thalamus.
  • Stereotactic Radiosurgery: Stereotactic Radiosurgery is a non-invasive procedure which involves the use of high-intensity ultrasound to destroy the specific points in the thalamus tissue that cause tremors.During the surgery, the nerve cells are monitored by using MRI technique. Thus, this technique is highly specific and it does not cause damage to the surrounding tissue. This procedure does not require anaesthesia, holes in the skull or insertion of electrodes. It was approved by Food and Drug Administration (FDA) in July 2016.

Therapy:

Physical and occupational therapies are done to improve the quality of life of the individual. They are discussed briefly below:

  • Physical Therapy: Physical therapy focuses on improving the mobility of the individual. It involves focussing on improving muscle strength, control and coordination. The individual is also trained in using assistive devices.
  • Occupational Therapy: Occupational therapy focuses on improving thepatient’s ability to perform daily activities like grooming, eating, walking etc. The individual is trained on how to use assistive technologies for easing daily activities.

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