March is Essential Tremor Awareness Month, and everyone at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders sends a vote of confidence and a word of encouragement to the more than 2,000 Gardner Center patients who are affected by this progressive neurological condition.
The Gardner Center is a center of excellence at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health.
Essential tremor is a movement disorder that is also known as familial tremor, benign essential tremor or hereditary tremor. It causes a rhythmic trembling of the hands, head, voice, legs or trunk and can make everyday activities, such as eating, drinking, dressing and writing difficult.
Although it does not garner as much media attention as Parkinson’s disease, it is at least three to four times as common as Parkinson’s, affecting an estimated 3.9 to 14 percent of all elderly individuals. Katharine Hepburn is the most famous American to have coped with the condition.
Although essential tremor has no definitive cure, up to two-thirds of patients have such mild symptoms that they do not require treatment. For the other third, treatment can involve medication and, in severe cases, surgery.
“There are two first-line oral treatments for essential tremor,” explains Alberto Espay, MD, a UC Health neurologist and movement disorders specialist at the Gardner Center. “One is an anti-epileptic drug called Primidone. And the other is an anti-hypertensive drug called Propranolol.
“It is an interesting situation in that you have two drugs that were really not designed for essential tremor but were given to patients for either epilepsy or hypertension. In the process, doctors discovered that patients who also happened to have essential tremor reported that their tremor improved while they were taking the drug. And that’s how we serendipitously have our two best drugs for essential tremor.”
Symptoms progress slowly for most patients with essential tremor, but over time tremors can become severe. At the Gardner Center, those patients have the option of undergoing surgery, which is performed by neurosurgeons George Mandybur, MD, and Ellen Air, MD, PhD.
Surgery targets the thalamus, the part of the brain that is overactive in patients with essential tremor. The most commonly performed surgical procedure is deep brain stimulation (DBS) surgery. During DBS tiny electrodes are implanted in a small part of the thalamus and connected to a programmable, battery-powered device that creates electric pulses. The device, which resembles a heart pacemaker, is implanted beneath the collar bone. The electrodes deliver a low-intensity current that continually pulses through the thalamus, neutralizing it without damaging it.
In a less commonly performed procedure, surgeons use an electrode to ablate (destroy) the overactive part of the thalamus.
Meanwhile, lifestyle changes may ease symptoms of essential tremor. Fredy J. Revilla, MD, Director of the Gardner Center and the James J. and Joan A. Gardner Family Chair, says that decreasing or eliminating the consumption of caffeine (e.g., coffee and caffeinated beverages) or other stimulants may reduce tremor, while hand and wrist exercises can promote hand stability. Although alcohol is known to reduce tremor, Dr. Revilla does not recommend alcohol consumption as a treatment because of the risk of alcohol dependence.
Essential tremor differs from Parkinson’s disease in some important ways. Whereas fewer than 10 percent of people with Parkinson’s disease have a family history of the disease, more than 50 percent of patients with essential tremor have a family history of their condition. While Parkinson’s usually starts on one side of the body and remains asymmetrical when progressing to the other side, essential tremor usually affects both sides from the beginning. And while the tremor in Parkinson’s is usually confined to the hands and, to a lesser extent, the legs, essential tremor predominantly affects the hands but can also affect the head, jaw and voice.
As many as 20 percent of patients with essential tremor may also go on to develop Parkinson’s disease, but researchers have not confirmed that essential tremor is a risk factor for Parkinson’s.
The Essential Tremor Support Group welcomes patients treated at the Gardner Center. The group shares information about new studies, medication, coping and helpful hints from 2 to 4 p.m. on the second Sunday of each month, except in May, when it meets on the third Sunday. Meetings are held at Sycamore/Kettering Hospital on Leiter Road in Miamisburg, Ohio, about one mile from I-75. Come to Dining Room 2 on the lower level. Meetings are free and open to anyone with essential tremor, as well as families, caregivers and friends. For more information, contact Arlene Rosen in Cincinnati at (513) 791-5546 or firstname.lastname@example.org or Norma Doherty in Dayton at (973) 433-0153 or email@example.com.
Lacking a Michael J. Fox,
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— Cindy Starr