Diagnostics

To diagnose essential tremor, a detailed medical history, a neurological examination and, if necessary, laboratory diagnostics are performed. The diagnosis of essential tremor is an exclusion diagnosis. All other diseases that could lead to this symptomatology are excluded by diagnostic measures, so that in the end it is very likely that the diagnosis of essential tremor can be made.

However, there are other criteria that can be helpful in making a diagnosis. For example, a symmetrical tremor of the postural and action muscles on both sides is usually detected. A resting tremor occurs very rarely and would rather indicate Parkinson’s disease.

Furthermore, the course of the disease is often progressive and long. Many patients also report relatives who also suffer from essential tremor during the conversation with the doctor. An improvement of the symptoms under alcohol consumption is not an exact criterion, but in case of doubt it can indicate the presence of the disease.

Symptoms

An essential tremor is a so-called action tremor. This means that the tremor only occurs when the person wants to perform an action, such as reaching for a glass of water. At rest there is no pronounced tremor.

The frequency, i.e. how fast the tremor is, and the amplitude, i.e. how strong the tremor is, can vary greatly. Generally speaking, with increasing age the frequency decreases, but the amplitude increases and the involuntary movements become more extensive.

This tremor can affect different areas of the body, but is usually symmetrical (side to side). On the one hand, it affects the extremities, here mainly the hands, but also the head (head tremor) and the vocal chords, which leads to a weak and shaky voice. These symptoms usually do not set in until adulthood. Most patients develop the first symptoms between the ages of 20 and 60, but these symptoms then become progressive. Children are only very rarely affected.

Treatment

Targeted therapy of essential tremor is relatively difficult, as the exact causes have not yet been sufficiently researched. However, some agents and treatments have been shown to be effective in recent studies. The first choice is a combination of propanolol (a beta-blocker) and primidone, which has an antispasmodic effect.Side effects such as dizziness, nausea and tiredness can occur, especially during the initial adjustment.

Other drugs being considered today are arotinolol (beta-blocker), clonazepam (benzodiazepine) and topiramate (anti-epileptic). If these drugs do not work, or if the side effects are too severe, surgery on the brain can also bring about improvement. In the past, a so-called thalamotomy was performed for this purpose, in which a part of the thalamus was destroyed by strong heat generation.

The thalamus is an essential part of the human brain and is often considered the ” gateway to consciousness”. However, pain and movement stimuli are also processed here. However, studies have now shown that high-frequency stimulation of the thalamus (by electrical impulses) leads to better results and has significantly fewer side effects over a longer period of time.

In principle, drug therapy of an essential tremor is always preferable to neurosurgical therapy, as the side effects of an intervention can be very serious. However, in severe cases, such therapy is the only remaining form of treatment. The main drugs used for drug therapy are beta-blockers and anticonvulsants, anticonvulsant drugs.

? blockers are actually used for cardiac arrhythmias, but an effect on essential tremor has also been accidentally proven. The reason for this effect is still unknown today.

The standard is a combination of propanolol, the beta-blocker, with a dose of 30-320 mg/day and primidone (30-500mg/day). If this combination does not help, there are some reserve preparations such as topiramate (400-800mg/d), gabapentin (1800-2400mg/d) and arotinolol (10-30mg/d). Alcohol is in no way a long-term effective and sensible therapy option.

In essential tremor, various herbal remedies can relieve the symptoms. The calming effect on the nerves is of primary importance. In addition, the hypersensitivity of the nervous system is reduced to relieve the tremor of the muscles.

This also reduces the restlessness that is caused by the rapid muscle movements in most patients. Yellow jasmine, for example, belongs to the herbal medicines. This can reduce trembling in the hands and also has a generally calming effect.

Wormwood herb can help with cramps that can be caused by the continuous muscle movements and twitching. Toadstool helps with the restlessness caused by tremor. Lemon balm also reduces restlessness and nervousness and also has a general calming effect on the nervous system.

Valerian can also help to relax and relieve cramps. Passion flower also helps with cramps and reduces nervousness, which often occurs in the context of the twitching associated with essential tremor. Furthermore, oat straw and lady’s slipper reduce the excessive sensitivity of the nervous system.

There are several remedies that can be used as part of a homeopathic therapy for essential tremor. These include Agaricus muscarius, the poison of the toadstool, Antimonium tartaricum, also known as nux vomica, and Aranin, a spider poison. Following the homeopathic principle, these substances are diluted to such an extent that they no longer have a toxic (poisonous) effect in these concentrations, but still have a positive effect on the symptoms of essential tremorSchüssler Salts can be used as a possible homeopathic remedy to alleviate the symptoms of essential tremor.

The most recommended remedies are Ferrum Phosphoricum (No. 3), Magnesium Phosphoricum (No. 7) and Lithium chloratum (No.

16). No more than three salts should be taken simultaneously. Depending on your needs, take 1-3 tablets three to a maximum of 6 times per day.

The tablets should be taken individually and should remain in the mouth where they can slowly dissolve. A few years ago, it seemed hopelessly possible to completely cure an essential tremor. With an appropriate drug therapy it was possible to delay the progression of the disease or to reduce the severity of the symptoms.

However, great progress has been made in this field since then. For example, it is now possible to achieve permanent symptom relief and sometimes even a cure by high-frequency stimulation of certain brain regions. This operation, which involves the insertion of electrodes into deep brain regions, is very safe with a complication rate of 0.3% and is a good therapeutic option for people with essential tremor for whom drug therapy has not produced the desired improvement.Taking small amounts of alcohol can sometimes cause a short-term reduction in tremor. However, the tremor often worsens over the next few days, showing that regular alcohol consumption is not a long-term solution to essential tremor. In addition, regular consumption of alcohol, even small amounts, is associated with the risk of alcohol dependency.