Since there is no known cure for tremors the aim of treatment for them is to remove or at least reduce the involuntary movements in the best possible way.
For patients with tremors that are mild and that have not prevented them from executing their daily routines, their tremors can just be simply observed. These patients should also learn to avoid factors that could exacerbate their tremors. These could be:
lack of sleep
caffeine from sodas and beverages like fizzy drinks, tea and coffee.
A moderate type of tremor can prompt the doctor to prescribe medication on the patient. Primidone and propranolol are two of the most effective drugs for moderate tremors. Around 50% to 75% of patients have found these drugs effective for lessening their tremor.
Primidone – This type of drug is an anticonvulsant which implies it can be used to address epilepsy. Primidone’s side effects can include feeling sick, drowsiness, and low blood pressure.
Another anticonvulsant, also commonly used to address tremors is topiramate. If primidone and topiramate are not effective enough, then an anticonvulsant coupled with propranolol may be prescribed by the doctor.
Propranolol – this medication is a beta blocker that is normally used to address hypertension (high blood pressure) and heart disease. Tremors are substantially reduced after taking propranolol within a few hours. This drug’s potential side effects can include:
Worsening of heart failure or pre-existing asthma
If all the above mentioned medicines do not work even if combined together, medications known as sedatives, alprazolam and clonazepam being the two most popular examples, have shown to be effective in treating tremors. Sedatives help relieve anxiety which can be important in improving tremor symptoms. One drawback though, of using sedatives is that it can be habit-forming and can cause drowsiness as well.
If still all the aforementioned medications do not work, some doctors will recommend botulinum toxin to address essential tremor. This drug is injected straight into the affected muscles in order to relax the muscles and prevent nerve transmissions.
Since botulinum toxin is considered a potent poison only very small doses are given to a patient. This type of medication is occasionally applied for that treatment of dystonic tremor. Dystonic tremor is a distinct kind of tremor whose effects include muscle tightening (contractions) and spasms.
In certain cases central tremor can be so severe that it can be a debilitating experience for a patient. It can disrupt the normal activity of a person and can render his medication useless. These are rare occasions but if they occur surgery may be the best option. For severe tremor two types of surgery are possible. They are:
deep brain stimulation
This type of surgery entails the creation of a small hole in the thalamus. A thalamotomy procedure has been proven to be quite effective in treating tremor.
One advantage thalamotomy has over deep brain stimulation is that this procedure avoids the need for follow-up appointments in order to replace batteries and check the pulse generator. The advantage of deep brain stimulation has over thalamotomy is that the latter has fewer side effects compared to the side effects that can arise which even then can still be prevented from occurring by abandoning stimulation altogether or modifying the parameters of stimulation.
Thalamotomy has certain side effects which can include:
hemorrhaging in the brain
balance and speech problems
problem thinking and confusion
Deep brain stimulation
This type of surgical procedure is about the insertion of small metallic needles (electrodes) in the thalamus. General anesthesia is used first on the patient before the needles are inserted into the patient’s head.
The electrodes are connected to a pulse generator that is implanted under the skin of the patient’s chest. A mild electrical current is produced by the generator to help control the patient’s tremor by regulating his brain waves.
Many studies have found that deep brain stimulation can reduce tremors by approximately 90%.
Side effects of deep brain stimulation can include:
General anesthesia complications like numbness and nerve damage
Fluid accumulation in the brain
Inspection of the surgical scar site
Occupational or physical therapy may be recommended by doctors for patients with tremors. Exercises like muscle coordination, control and strengthening are taught by physical therapists.
Occupational therapists are responsible for making essential tremor patients to adapt well to everyday living. Specific adaptive devices to help you perform your daily activities can be suggested by therapists. These devices include:
Heavier, wider writing tools
Heavier utensils and glasses
Acupuncture has been practiced in China for millennia. It entails a procedure utilizing reed-thin needles that are specifically inserted into the vital parts of a patient’s body. This treatment is grounded on the belief that the proper balance of the flow of energy (chi or qi) flowing through energy thoroughfares called meridians in the body is important for the patient’s overall heath and for the treatment of his condition. By repairing energy flow, a restoration and rebalancing of harmony will be restored to the body. Western medicine is slowly warming up to acupuncture and in fact, acupuncture is now considered one of the more popular alternatives for treating a lot of health issues.
A study published by the National Institutes of Health showed that acupuncture combined with propranolol had a total efficacy rate of 90% in the reduction of essential tremors compared to the results of those given propranolol alone which was 56%. There was no control group that was treated with acupuncture alone.
The conclusion than was that the oral administration of propranolol combined with acupuncture had greater therapeutic effect on essential tremor compared to that of the oral intake of propranolol only.
Amy-Sui Qun Lui is a board certified and licensed acupuncturist in Cleveland, OH and the founder of Asian Health Center.