Tremor: what is essential about it?

So let us discuss the diseases which can present with tremors.

1) Drug induced tremors: certain drugs can induce a tremor like I stated ealier. Drugs used to treat asthma (inhalers) and anti-epileptic drugs like valproic acid may induce a tremor in the hands.

2) Benign essential tremor: this as the name suggests is a benign tremor. Patients who have benign essential tremor usually have a postural tremor in their hands but may also have a head and speech tremor. They do not have any underlying neurodegenerative disorder and usually the tremor is not disabling and progressive. As the tremor is not disabling it may not need to be treated unless it causes social embrassement to the patient. Patients who have classical essential tremor notice that their tremor becomes less prominent if they consume alcohol (tremor is alcohol responsive).

3) Cerebellar tremor: patients who have cerebellar involvement (example if you have cerebellar tumor or diseases that involve the cerebellum such as multiple sclerosis) may also have a prominent kinetic (intentional) tremor.

4) Parkinson’s disease: patients who have Parkinson’s disease have a prominent resting tremor. This tremor is most prominent when their hands are at rest and becomes less prominent when they start to use their hands.

Treatment of tremors: like I mentioned earlier, not all tremors need to be treated. We usually treat tremors when they become disabling or socially embrassing to the patient. There are different classes of drugs that are effective for tremor of Parkinson’s disease, cerebellar tremor and essential tremor. Your doctor shall help in deciding what kind of medication may work the best for you. Sometimes if the tremor is particularly disabling and unresponsive to medication, it may respond to neurostimulation (deep brain stimulation). I shall discuss this in a separate post.

Dr. Sethi

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