Tremor (Trembling Disorder)

Essential tremor implies a disorder that causes an involuntary and uncontrollable shaking. Essential Tremor is the most common movement disorder, which can be diagnosed at any age.

What is Tremor (Trembling Disorder)?

Lexical meaning of the tremor is shaking. Shaking develops due to various reasons and disorders. Overactive thyroid gland (hyperthyroidism) and Parkinson’s disease may also cause tremor. However, the most common one is Essential Tremor. Essential tremor that means uncontrolled shaking movements without any clear cause is seen in one out of every 5 people older than 60.

It Is Confused With Parkinson’s Disease…

Essential Tremor is usually manifested by shaking in hands and head. Besides, it can be noted in jaw, voice and the entire body. Since tremor in hands is a common symptom of Parkinson’s disease, Essential Tremor can be confused with Parkinson’s disease. Shaking in hands at rest is a symptom that is also seen in Parkinson’s disease. In Essential Tremor, on the other hand, the patient’s hands shake while working. The exact cause of the shaking is determined with examination findings. Having Essential Tremor does not necessarily mean Parkinson’s disease will develop in the future. It should be remembered that they are two different clinical pictures.

Pay Attention To Inheritance!

Essential Tremor is a disease that can develop at any age. Even a 20 year old person can have tremor. Incidence rate increases as the age advances. In fact, the disease is detected in one out of every 5 people older than 65. Although the exact underlying cause of Essential Tremor is unknown, the inheritance has an important role. The history of tremor in elderly members of the family is noted in most of the patients with this disease.

The disease should be treated quickly as it deteriorates the quality of life and causes discomfort in social environments. The final diagnosis of disease is established based on the patient’s medical history and clinical examination. MRI is also a diagnostic method for the disease. However, examination findings are crucial for diagnosis.

Treatment Methods

Medication treatment is primarily used to treat the Essential Tremor. When there is no response to medication therapy or symptoms of the disease worsen, surgical methods are employed. There are two different surgical methods:

Brain Pacemaker (Deep Brain Stimulation)

A fine electric cable is placed to block the nerve signaling that leads to the tremor. One end of the electric cable is connected to a pacemaker in the chest. The pacemaker located on the anterior chest wall beneath the skin continuously sends electric current to the nucleus and alters its functions.

Needle ablation method

The nucleus located in the cascade causing those disorders in the brain is determined to stop the tremor and hinder the uncontrolled movements. Next, a small and tiny needle is advanced to the region in order to ablate the nucleus with electric energy.

Which Method Should Be Preferred?

Both deep brain stimulation and needle ablation have advantages and disadvantages. The method to be used is determined based on the patient’s age and severity of the disease. Ablation with electric current offers a major advantage: an electrode is inserted to burn the predetermined region and the procedure is totally completed after electrodes are removed. However, the option of redo surgery for the same region is limited, as the ablation causes irreversible results. Therefore, ablation procedure is not frequently preferred for young patients. Besides, deep brain stimulation is more likely to be preferred in case of bilateral tremors. Ablation of both sides may cause certain problems, such as difficulty walking and decreased tone of voice. If tremor recurs in patients with a neurostimulator placed one year ago, necessary pacemaker adjustments are made. Tremors can be stopped by increasing the electric energy to an extent. This is the major advantage of this procedure. The disadvantages include the risk of infection in the pacemaker and the need for replacing the pacemaker at certain intervals.

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