Essential Tremor Treatments

Essential Tremor Treatments

Neal Hermanowicz (Director of the Movement Disorders Program) gives expert video advice on: What are the drug treatments for essential tremor?; How is physical therapy used to treat essential tremor? and more...

How is 'thalamotomy' used to treat essential tremor?

The surgical treatment of essential tremor can involve a procedure called 'thalamotomy'. This involves drilling a hole in the skull about the size of a nickel and then inserting a thin wire electrode targeting a structure called a thalamus. Once the tip of the electrode is in place, it's either heated up or, in some cases, cooled down to actually injure the thalamus, causing a kind of a scar to be placed there. And that does effectively reduce tremor on the other side of the body. So, if you put the electrode into the right brain it will help the left hand tremor. The procedure is usually not done on both sides because of concern about the impact on speech, for example.

How is 'deep brain stimulation' used to treat essential tremor?

Deep-brain stimulation surgery is probably the treatment of choice as a surgical treatment for essential tremor these days, and it does work very well. This is very similar to thalamotomy, except there is no permanent injury applied to the brain. A hole is drilled into the skull. An electrode is advanced to the thalamus, and the electrode is permanently implanted there and connected by a wire underneath the skin to a battery source which is permanently placed underneath the skin in the area of the collar bone. The battery sends weak electrical currents to the electrode, which is again permanently implanted, causing the thalamus activity to be reduced. This works very effectively in reducing tremor and may be done on both sides.

What effect does surgical treatment have on essential tremor?

The surgical treatment of essential tremor, whether it thalamotomy or deep brain stimulation surgery is also most effective in alleviating the shaking of the hands and not reliably effective in alleviating head or voice tremor.

What are the drug treatments for essential tremor?

There are several medications that are used to treat essential tremor. Most commonly are two. A medication called Primidone which was developed as an anti-seizure medication but was found, incidentally, to be helpful in some people with essential tremor. Then the second medication that is commonly used is called Propranolol, or Inderall is another name for that medication. There are several others; Topiramate or Topamax more recently has been described as being beneficial for some people with essential tremor. A medication called Gabapentin, also known as Neurontin, has been sort of variably described and has had mixed results in the treatment of essential tremor. Medications that are from the Valium category have been occasionally reported as being beneficial for essential tremor. And sometimes these medications are used in combination.

What are the effects of essential tremor drug treatments?

All of the medications that are used to treat essential tremor are most helpful for hand tremor. Voice tremor is often poorly resistant to any of the oral medications and head tremor when present can also be very poorly responsive to any of the oral medications.

What are the side effects of essential tremor drug treatments?

The side effects of some of these medications that are used to treat essential tremor can be quite troubling. Propranelol, which is supposed to be a beta-blocking medication, can cause side effects of a sense of fatigue. It can lower the blood pressure and the heart rate and cause people to feel light headed or dizzy, or even have a faint-like feeling. Propranellol can also contribute to feelings of depression. It can cause sexual dysfunction in men; it can cause erectile dysfunction in men. Premidone or myceline, which is also commonly used for essential tremors, is a barbiturate medication so it requires caution with use with alcohol and it can be sedating, and that has potential impact on things like driving or other activities that require close attention.

How is 'Botox' used to treat essential tremor?

Another form of treatment is the injection of Botulinum Toxin into the affected limb. It's not addressing the brain abnormality but it can help dump down the muscle contractions that are actually contributing to the shaking. It's not a form of treatment that is appropriate for everybody, but it may be helpful for some people.

What effect does Botox injection have on essential tremor?

Head tremor, for people with essential tremor, could be improved upon, and is, in many cases, by use of Botulinum Toxin of muscles of the neck. The muscles of the neck that are involved with shaking of the head can be quieted down by selectively injecting them with Botulinum Toxin. That effect can be very beneficial for some people, and it has a duration of about three months and then it needs to be repeated.

How is physical therapy used to treat essential tremor?

For people with essential tremor who have balance problems, physical therapy could be beneficial in reducing the risk of falling. Now, falling is not a common complaint in essential tremor, but balance problems do occur in some, and that can be improved upon by seeing a physical therapist who's familiar with gaging, walking and balancing problems. Otherwise physical therapy has a very limited role in the treatment of essential tremor.