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Senior woman diagnosed with essential tremorDo you remember when your grandma had "shaky" hands. Or maybe it was your favorite uncle? They most likely suffered from essential tremor, a condition usually associated with age and often confused with Parkinson's disease.

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In This Essential Tremor Article:

Introduction to Essential Tremor
Difference Between Essential Tremor and Parkinson's Disease
Deep-brain Stimulation Procedure for Essential Tremor
Risks Associate with Deep-Brain Procedure for Tremor
Does Brain Scan Help With Diagnosis for Essential Tremor?



"We usually hear a family history with essential tremor," says Dr. Neal Hermanowicz, director of the movement disorders program at the University of California, Irvine, and professor of neurology. "In fact, we believe about 40 percent of the cases are hereditary but it's still not a clear-cut gene. While not as troubling as Parkinson's, some patients have a very difficult time because the tremor interferes with basic tasks. They give up eating in restaurants or signing checks, for example."

A recent discussion in this column about the potential benefits of brain-stimulation procedures in connection with controlling Parkinson's symptoms led to several reader inquiries asking for more details on essential tremor.


How do you know if a patient has essential tremor or Parkinson's?

It's true some people have a similar tremor with Parkinson's that can present diagnosis difficulties even for expert clinicians. But we now have brain scan procedures to help with the diagnosis and shed more light on the problem. They are new and not available everywhere and I am not saying every patient needs one.

The diagnosis for essential tremor also can be made by carefully listening to the symptoms, in most cases. In a typical case of essential tremor, the patient observes a gradual onset of tremor in both hands. Parkinson's is usually one side or the other. Essential tremor shows up typically when the patient is doing a task. With Parkinson's, the tremor could show only when the hand is at rest. Of course, the medications for essential tremor and Parkinson's diseases are different.


What is A Deep-Brain Stimulation Procedure?

Essential tremor and Parkinson's Disease are treated by deep-brain stimulation but we target different parts of the brain for each disease.
It's important to realize that deep-brain stimulation is not for every patient. Deep-brain stimulation has been described as similar to placing a pacemaker in the brain. Electrodes are placed in the brain while the patient is awake and reactions can be tested in the operating room. Then the patient is put under anesthesia and surgeons insert a thin, flexible wire and a pulse generator is placed in the chest.

Because there is a difference between Parkinson's and essential tremor, it's important to select patients for deep-brain stimulation very carefully. As previously mentioned, the Deep-brain stimulation procedure is not for everyone.


Are there risks associated with deep-brain stimulation?

Of course. It's reasonable to have a discussion about deep-brain procedure early in the process but the risks must be outlined. And they include the possibility of a stroke. Not all Parkinson's patients respond to deep-brain stimulation. We need to be clear about what can be achieved. It's always an elective procedure.


Let's go back to the brain scan we mentioned. Does it help refine the diagnosis?

Certainly. Tremors – whether essential tremor or Parkinson's, can change very gradually as time goes by. In fact, gradual change is most typical.
People with mild cases of Parkinson's can help establish the diagnosis with greater certainty as a result of the brain scan. It spares misdiagnosis as well as assuring the proper medications are prescribed. So this sheds more light on a patient's diagnosis, particularly if preventive medications do not seem to be working well.

You know, some people with a Parkinson's tremor don't change very much over 10 or 20 years. They don't develop cognitive or balance problems.
Another benefit of the scan is a measurement of dopamine deficiency. (Dopamine is a neurotransmitter that helps regulate body movements and response.)
Parkinson's results from a loss of dopamine while the neurotransmitter is not impacted by essential tremor.


About the Author:

Jane Haas Senior Care Expert and Writer




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