Tremor - Treatments

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Are there any treatments for tremor?

There is no cure for most tremors.The appropriate treatment depends on accurate diagnosis of the cause.

Some tremors respond to treatment of the underlying condition. For example, in some cases of psychogenic tremor, treating the patient's underlying psychological problem may cause the tremor to disappear.

Symptomatic drug therapy is available for several forms of tremor. Drug treatment for parkinsonian tremor involves levodopa and/or dopamine-like drugs such as pramipexole and ropinirole. Other drugs used to lessen parkinsonian tremor include amantadine hydrochloride and anticholinergic drugs.

Essential tremor may be treated with propranolol or other beta blockers (such as nadolol) and primidone, an anticonvulsant drug.

Cerebellar tremor typically does not respond well to medical treatment.

Dystonic tremor may respond to clonazepam, anticholinergic drugs, and intramuscular injections of botulinum toxin. Botulinum toxin is also prescribed to treat voice and head tremors and several movement disorders.

Clonazepam and primidone may be prescribed for primary orthostatic tremor.

Enhanced physiologic tremor is usually reversible once the cause is corrected. If symptomatic treatment is needed, beta blockers can be used.

Eliminating tremor "triggers" such as caffeine and other stimulants from the diet is often recommended.

Physical therapy may help to reduce tremor and improve coordination and muscle control for some individuals. A physical therapist will evaluate the individual for tremor positioning, muscle control, muscle strength, and functional skills. Teaching the person to brace the affected limb during the tremor or to hold an affected arm close to the body is sometimes useful in gaining motion control. Coordination and balancing exercises may help some people. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.

Surgical intervention such as thalamotomy and deep brain stimulation may ease certain tremors. These surgeries are usually performed only when the tremor is severe and cannot be controlled satisfactorily with drugs.

Deep brain stimulation (DBS), the most common form of surgical treatment of tremor, uses implantable electrodes to send high-frequency electrical signals to the thalamus. A battery-operated device called a neurostimulator is used to deliver electrical stimulation to targeted areas in the brain that control movement. The person uses a hand-held magnet to turn on and turn off a pulse generator that is surgically implanted under the skin. The electrical stimulation temporarily disables the tremor and can be reversed, if necessary, by turning off the implanted electrode. Batteries in the generator last about 5 years and can be replaced surgically. DBS is currently used to treat parkinsonian tremor, essential tremor, and dystonia.

Thalamotomy, involving the creation of lesions in the brain region called the thalamus, is quite effective in treating individuals with essential, cerebellar, or parkinsonian tremor. This in-hospital procedure is performed under local anesthesia, with the individual being awake. After the person's head is secured in a metal frame, the surgeon maps the brain to locate the thalamus. A small hole is drilled through the skull and a temperature-controlled electrode is inserted into the thalamus. A low-frequency current is passed through the electrode to activate the tremor and to confirm proper placement. Once the site has been confirmed, the electrode is heated to create a temporary lesion. Testing is done to examine speech, language, coordination, and tremor activation, if any. If no problems occur, the probe is again heated to create a 3-mm permanent lesion. The probe, when cooled to body temperature, is withdrawn and the skull hole is covered. The lesion causes the tremor to permanently disappear without disrupting sensory or motor control.

The most common side effects of tremor surgery include dysarthria (problems with motor control of speech), temporary or permanent cognitive impairment (including visual and learning difficulties), and problems with balance.

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See what others are saying

Comment from: JJ, 55-64 Female (Patient) Published: October 22

My head started shaking very slightly about a year ago. I underwent a lot of procedures and an operation, and thought that all the anesthesia depleted all my vitamins and minerals in my body. I have an excellent neurologist who found I have peripheral neuropathy, which causes tremors, leg weakness, body temperature drops, heart races and muscle twitches. It is debilitating. So far my only treatment is primidone (anti-seizure medicine). It's very important to check you vitamin levels. Many people are misdiagnosed. Ataxia due to a B-12 deficiency is also serious. So, please, don't give up. Do research on the web and keep on top of your doctors.

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Comment from: JeterfanNYyankees, 19-24 Male (Caregiver) Published: December 01

I have been suffering from tremors since I was 6 years old. Recently, I started getting a lot of anxiety about it because my head and hands were shaking all the time. It caused me so much stress because I was embarrassed all the time and afraid to go out in public. However, I finally found a solution that doesn't involve taking medicine. Diet was my answer. I have been gluten free and dairy free for 3 months now. My shaking has decreased dramatically and my head/hands don't shake anymore. It sounds crazy but it is true. I am only 20 years old and have had many doctors tell me I had social anxiety and depression. They weren't wrong, but what had caused this anxiety and depression was my diet. I tell my story to people out there with depression issues and they agree that it has helped a great amount. I always see people on blogs and forums talking about how much medicine they have to take. I used to take propranolol and Wellbutrin XL but they weren't working. The reason why the medicine isn't working is because your body is constantly sending that 'fight or flight' response to your brain causing shakiness and that feeling of anxiety. Think about it, when you put something in your body that you are intolerant to, your body is going to react and try to tell you to stop. That is the reason for all this shakiness and anxiety. Just try it and see how you feel. Drinking a lot of water and cutting out artificial sugar also helps a lot as well.

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