Essential tremor frustrating, sometimes disabling

<p>We celebrated my mother's diagnosis with champagne. She had suffered for years with hand tremors that refused to respond to medications given for Parkinson's disease, and each prescription came with dire warnings to avoid alcohol. But her neurologist had been wrong. Like almost 10 million other Americans, my mother had essential tremor, and with this new diagnosis she was finally able to have a sip of champagne again. Not only was she able to sip alcohol; it was recommended! A cause for celebration indeed.</p><p>Essential tremor causes a rhythmic tremor of the hands, head, voice, legs, or trunk. Both essential tremor (ET) and Parkinson's disease are neurologic movement disorders and the two are often confused. It has been estimated that even general neurologists miss the diagnosis of ET 25 to 35 percent of the time.</p><p>There are more than 20 different kinds of tremors, but ET is the most common. Eight times as many people have ET as have Parkinson's. It has been estimated that almost 5 percent of people ages 40-60 have ET, and up to 9 percent of those over 60. Men and women are equally affected. And although it is rare to see symptoms before age 10, even infants can have ET. Many patients do not seek medical care because of fear or lack of awareness.</p><p>Although ET does not shorten a person's lifespan, it can be frustrating and disabling. Daily life activities are challenging: eating, dressing, grooming and writing are all affected. Imagine trying to bring a forkful of food to your mouth and spilling it all over the table instead! Essential tremor can be isolating because those affected tend to stay in their homes so as not to be embarrassed by their uncontrolled shaking.</p><p>Those with symptomatic essential tremor have abnormal communications between specific areas within their brain. It appears to be a genetic disorder; if one of your parents had ET, you have a 50 percent chance of inheriting the gene. But not everyone who inherits the gene will get symptoms, and ET can appear without a family history, indicating that there may be other causative factors.</p><p>The diagnosis is made by a skilled and observant clinician. There are no lab tests, but your doctor may do some tests to rule out other common causes of tremors. Brain scans are not diagnostic, but they too may be used to rule out other diagnoses.</p><p>If you have essential tremor, is there a cure? The simple answer is no. But there are treatments and adaptations that can decrease the symptoms and the anxiety associated with tremors.</p><p>About 50 percent of patients respond to medication. Most commonly used is a beta-blocker like propranolol. Usually used for hypertension, this is the only drug currently approved by the FDA for the treatment of essential tremors. Daily doses of an anti-seizure medication called primidone will sometimes decrease symptoms and although side effects to this medicine are initially problematic, there are few long-term problems.</p><p>Patients who are able to drink alcohol will note that their tremors may be less severe for an hour or two after a drink, so they may use this as episodic short-term medication. Occasionally though, if alcohol is overused, the tremors will be worse when the alcohol wears off.</p><p>Botox injections have been used for especially severe or difficult-to-treat cases. Botox is costly because the injections must be administered by a specialist and repeated every three months, but in some cases the high cost is worth it.</p><p>Essential tremor can be threatening to lifestyles and occupations. New medications and treatments are being investigated for ET and there is hope for better medical management. But a great part of having ET is learning how to live with it. Seeking support from others who understand the challenges faced by those living with ET can make a difference. The more you know about ET, the easier it can be to minimize the effect it has on your day-to-day life.</p><p>On the Web, find Essential Tremor at www.essentialtremor.org.</p><p>Locally, contact Mike Tabulara, Sonoma County IETF Support Group Leader at 539-7836 or by e-mail: tabulara@pacbell.net</p><p>Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and has been certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hand-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail drkerr@the-doctors-inn.com.</p>