ESSENTIAL TREMOR AND MS

ESSENTIAL TREMOR AND MS

This time the info dokter99 will explain what it was essential tremors and ms?

Essential tremor is a muscle contraction ritnis but not deliberate by unknown causes. Essential tremor can occur in almost any part of your body, but pergetarannya often occurs in your hand, especially when you try to perform small tasks, such as drinking from a cup, tying shoes, writing, or shave. Essential tremor can also affect the head, voice, hands, and feet.

Although the condition is usually not dangerous, essential tremor may gradually start to deteriorate and can be severe in some people. This condition is not caused by a particular disease, although it is usually misdiagnosed as Parkinson's disease.

How common is essential tremor?

Essential tremor can affect men and women, usually over 65 years. If there is a family member who has a history of essential tremor, it usually will happen to another family member.

Signs and symptoms

What are the signs and symptoms of essential tremor?

Essential tremor can occur on the hands, head, facial structures, vocal cords, throat, and legs. Most often occur on the hands and arms. Tremor esensia lbiasanya affect both sides of the body, but is stronger on one side only. Tremor becomes more severe when the hands or feet being on a less comfortable position. But usually stops by itself.

Specific symptoms may include:

head nods

Sound vibration or shaking, tremor when attacking the vocal cords

Difficulty writing, drawing, drinking glass, or the use of a tool, if the attacking hand tremor

Still there are also some characteristics and symptoms that are not mentioned above. If you had the same complaints, please consult your doctor.

When should I see a doctor?

If you have signs or symptoms listed above or have any questions, please consult your physician. Everyone's body reacts differently. Always talk to your doctor about treatment methods of diagnosis and treatment is best for you.

CauseWhat causes essential tremor?

Although the cause is unknown, abnormal coordination between certain parts of the brain is thought to cause tremors. This condition is not contagious but can be passed down through families, with parents has a 50% chance to pass down to children.

These risk factors

What increases my risk for essential tremor?

Several factors can affect the tremor:

Genetic mutations. Type of essential tremor derived families (familial tremor) is an autosomal dominant disorder. A defective gene from only one parent has enough to drop this condition. If you have a parent with essential tremor genetic mutation, you have a 50 percent suffer from tremors on yourself

Age. Essential tremor is more common in people ages 40 and older

Drugs & Medications

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

What are my treatment options for essential tremor?

Some people with essential tremor may not require treatment if symptoms are mild. But if essential tremor inhibit daily activities, it is necessary to appropriate treatment by a physician:

Beta blockers. Commonly used to treat high blood pressure, beta blockers such as propranolol (Inderal) helps relieve tremor in some people. Other beta blockers which can be used include atenolol (Tenormin), metoprolol (Lopressor), nadolol and sotalol (Betapace)

Anti-seizure drugs. Epileptic drugs, such as primidone (Mysoline), may be effective in people who do not respond to beta blockers

Sedative. The doctor may use drugs such as alprazolam (Xanax) and clonazepam (Klonopin) to treat people with tremors were compounded by tension or anxiety

OnabotulinumtoxinA injections (Botox). Botox injections may be useful in treating some types of tremor, especially the head and voice. Botox injections can relieve tremors for at least three months

Operation: In severe cases, surgery may be tried. These may include:

The focus of the high-powered x-rays on a small area of ​​the brain (stereotactic radiosurgery)

Installing a stimulant in the brain to provide direction on areas of the brain that controls movement

Any test that is commonly performed for essential tremor

The doctor may make a diagnosis based on the track record of medical and physical examination. Other causes (eg, neurological disorders, thyroid conditions, the use of caffeine, and drugs) must be presented as well.

There are no specific blood tests, genetic testing, or x-ray studies to diagnose essential tremor. However, your doctor may ask you to perform blood and urine tests, CT or MRI scan to locate other possible causes of tremor.

Treatment at home

Any change in lifestyle or home remedies that can be done to cope with essential tremor?

Here are the kinds of healthy lifestyle and home remedies that can help you deal with these health problems:

Having an active lifestyle

Call your doctor if you suffer from side effects of drugs

Call your doctor if you are worried that you are suffering from Parkinson's disease

Follow the doctor's instructions, do not stop taking the medication without first asking your doctor's advice

Check up your health in a timely manner to track the progress of the disease and the condition of your health

If you have questions, please consult with your doctor for the best solution of your problem.

Tremor, or uncontrolled shaking, is a highly disabling symptom of multiple sclerosis which is often associated with a more advanced disease course.  Tremor, an involuntary, rhythmic, muscle movement caused by repetitive contraction and relaxation of paired muscle groups, has long been recognized as a feature of MS.  The French neurologist Dr. Jean-Martin Charcot (1825-1893) categorized it with nystagmus and scanning speech (Rascol, 1982).  

A study published in the open-access journal Tremor and Other Hyperkinetic Movements reviewed recent advancements in the understanding of tremors in MS.  The review explores the prevalence and clinical features of tremors in MS, including physical  cause of tremors, and treatment methods, including surgery and/or prescription medications.

Reviewers searched MEDLINE with the terms “multiple sclerosis” and “tremor,” published between January 1966 and May 2012.  My own search revealed articles dating back to 1958, and at least six additional relevant articles published since May 2012.

Prevalence of tremor in MS

Studies indicate that tremors are prevalent in 25% to 58% of the MS population.  Upper limb tremor was described in 58% of 100 randomly selected MS patients from an MS specialty clinic in London (potential for selection bias); 27% with minimal tremor, 16% with mild tremor, and 15% with moderate to severe tremor (Alusi, 2001).  In a community-based study of 200 MS patients in Olmsted County, Minnesota, tremor was noted in 25.5% of patients with severe tremor seen in only 3% of patients (Pittock, 2004)

Authors note that the prevalence of tremor in MS is difficult to establish because of the transient nature of MS symptoms, the lack of assessment for tremor in the EDSS, and the difficulty in distinguishing intention tremor from ataxia.

Assessment of tremor in MS

Tremor is an involuntary, repetitive, rhythmic movement of a body part.  A tremor present during rest (muscle relaxation) is different than an action tremor which is produced during voluntary movement.  The type of tremors seen in MS are action tremors, specifically postural tremor and/or intention tremor, often involving the arms, head, neck, and trunk. Vocal cords by also be affected.

Tremors which are not commonly seen in MS include rest tremor, task-specific tremor (such as while writing, for example), and simple kinetic tremor present during voluntary non-target-directed motions (such as opening and closing a fist).  In general, movement disorders other than tremor are uncommon in MS (Labiano-Fontcuberta, 2012).

Tremor classification and severity scales have not been widely adopted in MS practice. One scale, the Fahn-Tolosa-Marin Tremor Rating Scale, was adapted and tested for reliability in a study, but not for validity.  A 0-10 tremor severity scale devised by Bahn and colleagues in 1993 has been tested for validity and reliability in use with the MS population. However, it has only been used in a few clinical studies, according to review authors.

Cause of tremor in MS

Because MS is a disease which involves variable areas of the central nervous system, with almost infinite combinations of damaged areas and symptoms possible, the underlying cause of tremor is difficult to ascertain or link directly to specific lesions in the brain.  However, studies have supported a link between the cerebellum and MS-related tremor.

Tremor and disability in MS

Tremors typically develop in MS patients sometime around 11 years after disease onset, making them signs of advancing MS (Alusi, 2001).  In studies, tremor has been associated with more severe disability.  Patients with tremor are more likely to be wheelchair dependent and have worse EDSS scores (Alusi, 2001).  In fact, patients who show signs of cerebellar damage early on in the disease tend to develop severe disability more quickly (Amato, 2000).  Some signs of cerebellar involvement in MS include disturbed balance, gait ataxia (wide, staggering, or shuffling walk), poor muscle tone, and nystagmus.  In the Olmsted County study, patients with tremor were more likely to be unemployed or to have retired early because of disability.

Treatment of tremor in MS

Physical aids which may be helpful in patients with mild tremor include the use of electromagnetic fields, limb cooling, weight bracelets, orthoses, and physiotherapy.  In studies, the effect of limb cooling on intention tremor lasted for at least 30 minutes.  Some patients may benefit from restricting caffeine intake or other stimulants which increase symptoms.  Relaxation methods aimed at alleviating the anxiety or stress may help other patients for whom these symptoms make their tremors worse.

Available medications aimed at treating tremors are unsuccessful in most cases, according to review authors.  Patients have experienced some relief from other drugs, including an anticonvulsant (primidone), sedative (glutethimide), tuberculosis medication (isoniazid,) and intrathecal baclofen.  Marijuana has been been found to have no positive effect on tremors in several randomized controlled trials.  The anti-seizure medication, levetiracetam, has been studied but its benefit is unclear.  Studies have explored the use of topiramate (Topamax), a migraine medication, in treating tremor and ataxia in MS patients.  Results look promising.

Options for surgical treatment include stereotactic thalamotomy, a procedure that severs nerve fibers from an area of the brain called the thalamus, and deep brain stimulation (DBS) which involves implantation of small electrodes in the brain to stimulate and change brain activity.  Stereotactic thalamotomy has been used since 1960 to combat MS tremor (Cooper, 1967).  One study reported positive use of gammaknife thalamotomy, but further studies have not been published.

Three studies have compared thalamotomy and DBS in MS patients.  Schuurman et al. (2000) did not find significant differences between thalamotomy and DBS in functional outcome for a subgroup of MS patients.  Yap et al. (2007) concluded that both thalamotomy and thalamic DBS were comparable procedures for tremor suppression, each associated with adverse effects.  In a nonrandomized study, thalamotomy was more effective in treating MS tremor, with 78% reduction of postural tremor and 72% reduction for intention tremor, than deep brain stimulation, which showed 64% and 36% reduction, respectively (Bittar, 2005).  DBS is currently the accepted surgical intervention for MS tremor, however larger clinical trials comparing both interventions are needed.  Long-term follow-up is also needed to determine which intervention(s) may result in persistent improvement.