Essential Tremor

Common movement disorder characterized by a postural tremor of the hands that can be accompanied by tremor in other body parts such as the head, tongue, larynx, trunk or legs.

Also referred to as benign tremor or familial tremor or shaky hand syndrome.

Cause unknown.

The most common movement disorder.

Most common form of pathologic tremor.

Prevalence as high as 4%.

prevalence is approximately 1% in the general population and 45% among persons older than 65 years of age.

Associated with adverse effects: social isolation, phobia, depression, and interference with work.

Population studies suggest a range of prevalence from 0.4-6.3% (Louis ED)

Estimated 10-20,000,000 individuals United States had essential tremor.

Prevalence increases with age.

Cause unknown but many have family history consistent with a Mendelian dominant genetic pattern.

Linked to a polymorphism in the gene encoding leucine-rich repeat and immunoglobulin domain containing protein 1 (LINGO).

Characterized by a rhythmic oscillation of agonists and antagonists muscle groups typically between 8-12 Hz.

20 times more common than Parkinson’s disease.

Not a medically dangerous process, but is progressive and disabling.

Patients often have social phobias and depression.

Beta-blockers initial treatment.

Medical therapy is often successful.

Up to 50% of patients with essential tremor cannot tolerate therapeutic medications or have refractory tremor.

Effectively treated with propranolol and primidone.

Alcohol can diminish tremor in many patients.

Deep brain stimulation surgical treatment of choice, with a 70-90% tremor control.

Treatment of head and voice tremor with deep brain stimulation is less effective.

Ventralis intermedius nucleus to the thalamus is the most appropriate target for treatment.

An association exists for essential tremor and spasmodic dysphonia with a 79% female preponderance.

Botulinum toxin type A is effective to varying degrees in the treatment of essential limb trimmer, prevents the release of  acetylcholine in synapses, leads to reduction in aberrant muscle movement.

The injection of botulinum toxin into the splenius capitis muscle is more effective than placebo in reducing the severity of isolated or essential head tremor at 18 weeks, but not at 24 weeks, and is associated with adverse effects, including head and neck pain, posterior cervical weakness, and dysphagia (Marqvues A).

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