Essential hand tremor - causes, symptoms, diagnosis and treatment

Essential tremor is a slowly progressive hyperkinesis that reflects dysfunction of the nervous system associated with damage to the morphological structure of the medulla. The prevalence of the disease is about 7% in the age group under 40 years. Pathology is detected in 17% of patients aged 70-80 years. ET is detected with equal frequency in patients of both sexes (men, women).

Characteristics of the pathology

Tremor is a common hyperkinesis (uncontrolled pathological movement provoked by involuntary contraction and relaxation of a group of flexor and extensor muscles). Trembling of the limbs is associated with various pathologies of the nervous system (damage to cortical structures, cerebellum, peripheral nerves), which causes certain difficulties in differential diagnosis and elucidation of etiological causes.

Essential tremor is a disease that is characterized by slow progression, which makes early diagnosis particularly important. The pathology is characterized by spontaneous trembling of the hands, forearms, and less commonly the head and lower extremities. Patients exhibit intentional and postural tremors of a bilateral type. Symmetrical trembling in parts of the body is constantly observed and is noticeable.

Both types of trembling (postural, intentional) are actional - they develop with voluntary muscle tension. Postural occurs against the background of muscle tension in a static position (when trying to maintain balance in a given position). Intentional occurs when purposeful movements are made, usually intensifying as one approaches the goal. ET is classified as a neurodegenerative disease based on factors (according to neuroimaging results):

Pathological changes in the morphological structure of the cerebellar cortex.
Destruction, reduction in the volume of nerve fibers consisting of Purkinje cells.
Presence of Lewy bodies in the locus coeruleus (a nucleus located in the brain stem, part of the reticular formation).

Causes of the syndrome

There are 2 main reasons why essential tremor may develop:

Heredity is the main cause of essential tremor. The gene mutation is passed on from parents to their children. If parents have this disease, in half of all cases they will have a child with essential tremor. The disease can appear at any age, but is most often diagnosed in older people.
The second reason is improper interaction of brain structures such as the cerebellum, brain stem and red nuclei, which are responsible for coordinating movement.

Essential tremor can also be caused by the following diseases:

Parkinson's disease (gradual death of brain cells occurs);
hepatolenticular degeneration;
thyrotoxicosis, hyperparathyroidism (dysfunction of the thyroid gland);
renal and liver failure;
stroke, brain tumors (death of brain cells);
head injury (damage to brain cells);
intoxication, drug poisoning;
idiopathic muscular dystonia;
cerebellar degenerations.

Types of disease

Essential tremor has many names, including familial, hereditary, idiopathic, benign, Minor's tremor (after the name of the doctor who first described it in detail). In all cases we are talking about the same disease. There are types:

Hereditary (about 50% of cases).
Sporadic (occurring spontaneously). The diagnosis is made in patients under 65 years of age.
Senile (associated with physiological aging of the body). The diagnosis is given to patients over 65 years of age.

Essential tremor in most patients manifests itself in the upper extremities and forearms, less often in the head and legs. Morphological changes in brain structures are not always detected, which makes it difficult to make a differential diagnosis.

How to recognize essential tremor?

Since essential tremor has not yet been studied enough, it would not be surprising if it appears in individuals who do not have a history of sick parents or pathologies in the connections between brain structures. They can identify symptoms of essential tremor in themselves, as well as in people who clearly suffer from it:

Trembling of hands, head, eyelids, legs. They appear more actively when a person tries to do something with these parts of the body, for example, gets up, runs, writes, eats food, etc. In a calm state, the tremor becomes less pronounced, but is present.
Trembling of the tongue, which is a characteristic sign that identifies essential tremor. Usually the patient himself and his relatives do not notice this sign.
Unreasonable nods of the head, which are similar to the position of a person who agrees with the opinion of the interlocutor.
Slightly increased muscle tone.
A change in the timbre of the voice, as if the person is worried, although in fact he does not experience any excitement.
Increased tremors in the hands, head and other parts of the body in situations of stress, emotional problems or conflict with other people. This may include situations of physical fatigue, drinking alcohol or caffeinated drinks, feeling hungry, hypothermia, and staying in crowded places.
Trembling of the upper extremities of medium or small amplitude with unchanged muscle tone.
Absence of any deviations in mental activity. A person with essential tremor does not lose memory or become weak-minded.

The disease often affects the wrist and finger joints. At first, tremor occurs only when a person tries to perform any action with them. Then tremor begins to occur at rest, when the shaking becomes small and frequent. Over time, the amplitude of the jitter increases and the frequency decreases.

Over time, a person begins to experience various difficulties in performing small activities, for example, writing, threading a needle, etc. Fine motor skills become difficult, although they are not completely lost. This causes certain difficulties in performing their work duties.

Usually doctors are able to cope with tremors of body parts. However, if a person resorts to self-medication, then this therapy becomes ineffective.

The above symptoms of essential tremor are accompanied by other signs:

Spasmodic torticollis and pathological position of the head.
Oromandibular dystonia is a contraction of the masticatory muscles.
Blepharospasms are involuntary contractions of the orbicularis oculi muscles.

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Causes

The main cause of essential hand tremor is a hereditary predisposition. The family nature (autosomal dominant and non-Mendelian type of inheritance) of the pathology is detected in 50% of cases. It is assumed that the causes of the appearance are associated with increased activity of the thalamus (according to PET results). The thalamus is not the initiator of hyperkinesis, but contributes to an increase in its severity.

The development of the pathological process is provoked by cerebellar dysfunction. The results of positron emission tomography show the presence of cerebellar activation in the pathogenesis. Magnetic resonance spectroscopy reveals a decrease in the concentration of the amino acid N-acetylaspartate in the cerebellar tissue, which indicates neuronal dysfunction.

As a result of disturbances, rhythmic oscillations occur in the cortical-ponto-cerebello-thalamocortical loop. This is why pathological trembling of body parts occurs. According to the results of clinical studies, ethanol suppresses the functions of the cerebellum, which leads to a decrease in the symptoms of ET.

Forecast

Essential tremor is not a life-threatening condition. In addition, even if the main symptoms worsen, the disease will not be able to in any way affect a person’s intelligence and longevity.

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Although some symptoms of ET can negatively affect a person’s professional activity and prevent him from caring for himself over time, since severe tremor does not allow a person to eat and dress independently with the usual ease.

The disease cannot be stopped completely, but regular therapy will minimize the symptoms of the pathology.

Symptoms

Treatment of essential hand tremor is carried out after identifying the causes, taking into account the dominant symptoms. Main manifestations of the disease:

Postural tremors. Appears when trying to hold a position, for example, an extended limb.
Intentional tremors. Occurs during purposeful movement with a tendency to intensify during the process of planned completion. For example, when a person reaches out to take a glass, the shaking increases as they approach it. With ET, intentional tremors are less pronounced than postural ones.
Rest tremor. Trembling occurs when a person does not make a movement. The symptom sometimes appears in the later stages of the disease.
Ataxia (possible symptom). Impaired coordination of movements due to incorrect contraction of a muscle group while maintaining normal muscle tone. More often it manifests itself as a violation of tandem walking (in a straight line with the obligatory observance of the condition - the heel of the front leg is in contact with the toe of the leg located behind).
Cognitive disorders (deterioration of memory, mental activity) of mild to moderate degree. Mild psycho-emotional disorders with hereditary tremor can manifest themselves as an existential crisis, a depressive state, or neurosis.
Hyposmia (decreased sense of smell).

In the early stages, trembling appears under the influence of provoking factors - stress, physical fatigue; later the symptoms become stable, the intensity and amplitude of oscillatory movements increase. Additional symptoms may periodically regress and reappear. There are known cases of asymmetric manifestations of trembling of the limbs.

Clinical picture[ | ]

The main clinical manifestation of the disease is bilateral action tremor in the hands, which appears during movement (kinetic tremor) and/or when voluntarily holding a certain position (postural tremor). Tremor usually appears in both hands at once or first in one, and then with a short delay (no more than a few months) in the other, but its amplitude in one hand may be higher than in the other, so the symmetry of the tremors is relative. Moreover, in a number of familial cases (4.4%) with an autosomal dominant pattern of inheritance, patients with both bilateral and unilateral tremor were observed. However, sporadic cases of unilateral action tremor are not usually classified as ET. Initially, the tremor involves the distal parts of the arms, then the trembling spreads in the proximal direction and to the axial parts (head, larynx, rarely torso).

It is believed that ET is characterized by a benign, slowly progressive course. It is worth noting that in more than 80% of patients who sought medical help, tremor caused difficulties in daily activities, for example, limiting the ability to eat or dress independently.

Kinetic hand tremors can occur during a variety of voluntary movements, including drinking from or pouring water from a glass, using cutlery, or writing. Kinetic tremor often intensifies at the last point of a goal-directed movement (the so-called “terminal intensification”), but sometimes it has a more clear intentional character, increasing as it approaches the goal. Postural tremor of the arms (eg, when holding the upper limbs in an extended horizontal position in front of the body) usually has a smaller amplitude than kinetic tremor. Tremors in the hands most often include flexion/extension of the hands, abduction/extension of the fingers, much less often it has a rotatory nature (pronation/supination), which is more characteristic of parkinsonian tremor. As the patient's age increases, there is a tendency for the tremor frequency to decrease to 4 Hz.

Head tremors occur in approximately 30% of patients with ET. Head shaking can be represented by a “yes-yes” or “no-no” oscillation. Isolated head tremor, previously considered a special variant of ET, is currently not included in ET. However, this issue has not been finally resolved. Head tremor that occurs against the background of a dystonic posture is usually a variant of focal dystonia. Usually it is more pronounced when turning the head to one side (opposite to the direction of dystonic cravings). At a later stage, tremors involve the vocal cords (about 20% of cases), face/jaw (about 10%), tongue (about 20%), trunk (about 5%) and lower extremities (about 10%). of the tongue, soft palate, and vocal folds, patients may experience mild dysarthria, but it is rarely observed before 65 years of age.

During the day, due to the daily rhythms of physiological processes and changes in the emotional state, fluctuations in the amplitude (but not frequency) of tremor are possible. Under the influence of stress, overwork, increased temperature, or taking psychostimulants, the severity of trembling may temporarily increase. Like other extrapyramidal syndromes, tremors decrease or disappear completely during sleep.

With the classic version of ET, there are no other neurological manifestations, however, in the clinic there are often cases where trembling, similar to ET, is accompanied by other neurological symptoms. Among them are cerebellar (impaired tandem walking, intention tremor, dysmetria), dystonic symptoms (head posture, writer's cramp, blepharospasm), symptoms of parkinsonism (rest tremor, hypomimia, bradykinesia, tendency to achyrokinesis). These are usually “mild symptoms” that are not clinically significant, i.e. not reaching the degree of severity that allows diagnosing a particular neurological syndrome. In recent years, in such cases it has become common to diagnose ET-plus. The recently published diagnostic criteria for ET, developed by the International Parkinson's Disease and Movement Disorder Society, include the definition of ET-plus for the first time. In some patients with ET, in addition to kinetic-postural tremor, resting tremor is observed in the absence of rigidity or bradykinesia. These patients have more pronounced and widespread postural-kinetic tremors. It should be taken into account that rest tremor during ET has some peculiarities, being only a continuation of pronounced postural-kinetic tremors, has the same frequency characteristics, and does not decrease with movement. In this regard, it is more correct to define this type of tremor as “tremor at rest.”

Diagnostics

Examination of patients requires a thorough history taking. The doctor finds out the duration of symptoms, factors that increase or help weaken pathological twitching. Other important information for making a diagnosis:

The presence of similar disorders or other neurological pathologies in relatives.
Presence of accompanying symptoms (gait disturbance, motor coordination disorder).
History of neurological and somatic chronic diseases.
The fact of taking pharmaceutical drugs (neuroleptics, antidepressants).

Differential diagnosis is carried out in relation to Parkinson's disease and other types of tremor. A correct diagnosis allows you to choose the right treatment tactics. According to statistics, in medical practice, the diagnosis of Parkinson's disease is mistakenly made instead of essential tremor (in both cases, trembling of the hands occurs more often, less often of the head) in 30-50% of cases.

As a result, patients have been taking specific drugs (for example, Cyclodol) for many years without appropriate indications. It should be taken into account that in 5-19% of patients essential tremor is combined with Parkinson's disease. In these cases, patients simultaneously exhibit different types of tremors: postural, intentional, at rest, and other symptoms typical of PD. The diagnosis of ET is made according to the following criteria:

Postural tremor of a bilateral type, affecting the areas of the hands and forearms, may be accompanied by intention tremor.
The duration of these symptoms is at least 3-5 years.
It is possible that other areas may be involved in the pathological process - the head, larynx, tongue, lower extremities.

Symptoms of the disease

The most common sign of pathology is hand tremors of small or medium amplitude frequency.

The muscle tone remains unchanged. Trembling occurs in the wrist joints and fingers.

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At the very beginning of the disease, tremor appears when performing any work or under stress.

Gradually, trembling can also occur at rest, with the amplitude increasing and the frequency decreasing.

The tremor increases with physical fatigue, emotional excitement, drinking alcohol or coffee, feeling hungry and cold, while staying in public places.

Gradually, a person loses his ability to work, as he is incapable of basic actions.

Writing is especially difficult for patients.

Unlike Parkinson's disease, tremor does not cause dementia or impairment of the ability to think, which is why it is called essential tremor.

The symptoms of essential tremor are:

slight trembling in the hands, which is present in a mild form at rest and intensifies with excitement (when writing with a pen, bringing a cup to the mouth);
frequent and small movements of the head such as nodding “yes-yes”, “no-no”;
trembling of the tongue when it sticks out of the mouth;
trembling in the voice when speaking, reminiscent of vibration;
slight increased tone in the muscles;
increased trembling after stressful situations, emotional stress;
absence of tremor during sleep.

Treatment methods

Treatment methods for essential tremor are primarily aimed at eliminating symptoms. When choosing types and doses of medications for essential tremor, the doctor takes into account the level of discomfort (degree of disability) of the patient. The main medications prescribed for essential tremor are Propranolol (a non-selective beta-blocker) and Primidone (an antiepileptic drug of the barbiturate group). Second choice drugs:

Alprazolam (a drug that relieves anxiety and nervous tension).
Atenolol (beta-blocker of a cardioselective type).
Gabapentin (anticonvulsant, antiepileptic drug).
Sotalol (non-selective beta blocker, potassium channel inhibitor).
Topiramate (anti-epileptic drug).

The effectiveness of the non-selective beta-blocker Propranolol (Anaprilin) is due to the slowing down of the process of glycogenolysis (the breakdown of glycogen into glucose) in skeletal muscles, which leads to their relaxation. In 50% of patients, a decrease in twitching is observed after a course of drug therapy (daily dosage 120-320 mg).

The amplitude of tremor of the upper extremities decreases by an average of 55%. Possible adverse effects: disorders of the cardiovascular system, bronchospasm (difficulty in exhaling, shortness of breath), impotence (in men), decreased libido (in women).

Consequences and prognosis

Hereditary tremor does not affect the patient’s life expectancy, but worsens its quality, including social adaptation. Many patients develop a feeling of inferiority and decreased self-esteem; in rare cases, the disease leads to loss of ability to work and disability. The prognosis is relatively favorable. Correct therapy reduces symptoms and slows the progression of the disease.

Essential tremor is a neurodegenerative, slowly progressive disease that manifests itself as pathological, involuntary twitching, most often of the hands and forearms, less often of the head and legs. Intense trembling worsens the patient's quality of life and sometimes causes disability. Correct treatment in most cases reduces symptoms.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Essential tremor - causes, symptoms and treatment

Essential tremor is a disorder of the nervous system. The disease does not pose any danger, but has a lot of unpleasant symptoms. A patient with pathology cannot even drink water normally or read a book.

This all causes discomfort and makes life much more difficult. With the disease, tremor of the tongue, head, and voice may occur. Most often, the disease manifests itself between the ages of 30 and 40 years .

Essential tremor can be inherited. If the first symptoms appear, you should not ignore them and consult a doctor. A neurologist will examine you and order tests to find the cause of your essential tremor.

Essential hand tremor: symptoms, causes, diagnosis, treatment and prognosis

The diagnosis of tremor refers to rhythmic trembling of the arms, head and torso caused by vibrations of certain muscle groups. The most common is essential hand tremor. This disease does not cause harm to health, but its progression often leads to inconvenience in everyday life.

Peculiarities

The essential type of tremor is a hereditary type of disease and is a pathology of the central nervous system. The disease can appear at any age, but most often it affects people over 50 years of age. The disease is detected equally in both males and females.

Symptoms in the form of trembling of the upper extremities are associated with a delay in the transmission of nerve impulses, as a result of which movements are adjusted to a certain average value. The disease is considered benign and does not affect a person’s life expectancy.

This pathology cannot be called rare, since it is diagnosed in more than 3% of the population. Modern medicine has not yet been able to explain the underlying causes of essential hand tremor, so a treatment process has not been developed for a complete recovery from this pathology.

Symptoms of essential tremor

Essential tremor, or Minor's disease, is the most common hereditary disease of the central nervous system. In different regions it occurs with a frequency from 0.3% to 12.6%. Mostly people over 65 years of age are affected.

Essential tremor is a disease whose only manifestation is trembling. This trembling with essential tremor is varied in localization, severity, prevalence, characteristics, and age of onset.

The most characteristic of essential tremor is medium-amplitude and small tremors of the hands - alternating contractions of antagonist muscles: flexors and extensors. The muscle tone does not change. Trembling is noticeable with every purposeful movement and persists (even slightly intensifies) when approaching the target. Rest tremor with essential tremor is rare (more often in patients over 60 years of age).

Continuous movements or actions are impaired already in the early stages of the disease. And purposeful intermittent movements (even those requiring precision) remain accessible for a long time, because patients develop compensatory techniques during their illness, thereby maintaining professional fitness for several years.

As the disease progresses, patients become unable to work. Some patients have difficulty caring for themselves: they cannot use a spoon, have difficulty drinking liquid from a glass, cannot fasten buttons, etc. Emotional disturbances layered on top of the manifestations of tremor lead to everyday and social maladjustment of patients to varying degrees of severity.

Hand tremor with essential tremor appears in most patients earlier than tremors of other localizations, and can remain the only symptom for several months or even years. Most often, both hands begin to tremble at the same time, less often - only one hand (for right-handers, the right, and for left-handers, the left), and the other hand may begin to tremble after some time (sometimes several years).

Head trembling is observed in 50% of patients. It may also be the first manifestation of the disease, and tremor of the hands (or other localization) appears later. Head movements to the left and right are more often observed, less often - up and down or circular and diagonal types of tremor.
Quite often (60% of patients) tremor of the facial muscles is observed in the form of trembling of the lips when talking or smiling. Individual rapid small twitches of the facial muscles may also be noted. This type of tremor can also be an early manifestation of the disease.
Mild tremor of the eyelids and tongue may also be observed.
In elderly and middle-aged patients with a disease duration of more than 10 years, voice tremors are noted (in 35-30% of patients). But in 20% of cases it can be observed before the age of 20 years with a disease duration of up to 5 years.
20-25% of patients experience leg tremors.
Tremor of the entire body is rare and indicates a generalization of the process. Occurs more often during physical activity or anxiety.
Vibration of the diaphragm is rare and is confirmed by x-ray. The combination of trembling of the lips, tongue, vocal cords and diaphragm leads to disruption of the rhythm of breathing and speech.

Tremor of any localization with essential tremor increases with the expression of emotions, significant physical activity, and hypothermia. Alcohol intake reduces essential tremor on the day of intake, but increases it the next day.

There are children's, youth's forms of essential tremor, mature and senile forms. Often the onset of the disease is noted in childhood or adolescence.

Essential tremor is a benign tremor. It does not pose a threat to life, but has a progressive course.

Differential diagnosis of various types of tremor with essential tremor

The most important thing is to be able to distinguish one type of tremor from another. Below are some features of the “handwriting” of this or that type of tremor that you need to pay attention to when diagnosing.

Tremor in Parkinson's disease and essential tremor (ET)

muscle tone in ET remains unchanged, in contrast to rigidity (hypertonicity, hypertension) in parkinsonism;
posture and gait in patients with ET are not changed, unlike Parkinson's disease;
ET is typically characterized by a trembling of tension and movement that accompanies every purposeful action and intensifies when approaching the goal. Parkinsonism is characterized by resting tremor, which is not typical for ET;
In parkinsonism, purposeful movements, on the contrary, suppress tremor;
Familial cases of Parkinson's disease are extremely rare.

Essential tremor (ET) and torsion dystonia (TD)

In TD, tremor is rarely the only symptom. As a rule, disturbances in muscle tone are soon observed, leading to changes in movements;
TD is characterized by the formation of fixed pathological postures, and tremor progresses much less frequently or does not change.

Essential tremor and hepatolenticular degeneration (Wilson-Konovalov disease, WLD)

the nature of tremor in ET and GLD is very similar, but in patients with GLD, intention tremor (when approaching a target) is much more pronounced, as well as an increase in tremor when holding the arms suspended;
it is necessary to pay attention to the results of studies of the liver, blood coagulation system, and also take into account mental changes in the form of intellectual impairments occurring against the background of euphoria, which is very typical for the early stages of GLD and is not typical for ET;
The most important thing in diagnosing DHF is the study of copper metabolism. If the exchange is disturbed (high content in the urine, low content of ceruloplasmin, the corneal Kayser-Fleischer ring is burdened with yellowish-green or greenish-brown pigmentation along the periphery of the cornea), this indicates the probable development of GLD, and not ET.

Essential tremor and multiple sclerosis (MS)

Even mild manifestations of visual impairment, detected at the onset of MS, are not typical for ET;
familial forms of MS are an extremely rare phenomenon, in contrast to familial (essential, hereditary) tremor.

Essential tremor and neurotic tremor (psychogenic tremor, PT)

PT has a higher frequency and lower amplitude in comparison with ET, it is unstable, often disappears when taking sedatives, psychotherapy and autogenic training. In case of ET, such measures are insufficient;
with ET, after drinking alcohol (after 15-20 minutes), the trembling disappears.

Essential tremor and thyrotoxic tremor (TT)

TT is characterized by a smaller amplitude and a higher frequency (the opposite for ET);
in case of Thyrotoxicosis, the decisive factor is the diagnosis of the thyroid gland with an increase in its function, weight loss, tachycardia, insomnia, sympatho-adrenal type disorders (excitation of the nervous system with increased release of adrenaline), changes in hormonal levels. With ET, such simultaneously occurring symptoms are not observed.

Essential tremor and metal intoxication (mercury, manganese, lead poisoning)

manganese poisoning most often leads to the development of parkinsonism, but not ET;
With mercury and lead intoxication, along with tremors, other symptoms of central nervous system damage develop, as well as polyneuropathy (damage to the nerve fibers that make up various nerves, including cranial nerves, manifested by symmetrical flaccid paralysis and impaired sensitivity). These symptoms are absent in ET.

These are brief information about the differential diagnosis of clinical forms of tremor with Essential tremor. We hope this article will help you in making a correct diagnosis.

Causes

The causes of essential tremor are not fully understood.
In approximately 50% of cases, it is an inherited disease as a result of a gene mutation. The number of cases in one generation often exceeds 50%. If both parents had tremor, then the number of patients in the first generation is close to 75%. But there are also sporadic (isolated) cases of essential tremor, the cause of which remains unclear. It can appear in anyone at any age. There is probably a genetic predisposition to this disease.

Main causes of essential tremor

The factors causing the occurrence of the disease are not fully understood at the moment. Usually there are two groups of reasons:

In some cases (about half of all patients), the appearance of the disease is explained by genetic mutations. Moreover, in the first generation there may be more patients - in the case when both parents have a damaged code, the number of those with tremors increases to three quarters of the total. The same group also included people with a sporadic form, which is not explained in any way in modern medicine. The disease occurs in both sexes equally often. Mature people are more susceptible to it.

Thyrotoxicosis can lead to essential tremor

The second reason is functional disturbances in the interaction of individual brain structures, such as the red nuclei, cerebellum and brain stem. The lack of normal communication between these organs leads to a decrease in regulatory functions over the voluntary activity of the body. This type of essential tremor also appears as a consequence of infection with thyrotoxicosis, shaking paralysis, kidney and liver dysfunction, hemorrhage, brain injury or tumor, and many others.

Treatment

Patients whose manifestations of essential tremor are mild do not require drug treatment. It is enough for them to exclude caffeine-containing drinks (tea, coffee) from their diet, stop drinking alcohol and smoking, and engage in physical exercise in the fresh air; Avoid stressful situations whenever possible.

Severe essential tremor (especially hand tremor) in most cases can be successfully treated with medication. The earlier treatment is started, the better the results.

Symptoms

The main symptom is that the hands tremble strongly due to changes in muscle tone. As a rule, trembling is observed in the fingers and wrist joint. Tremor occurs during tension, as well as when performing certain tasks. Sometimes the limbs tremble at rest. Trembling may worsen in the following situations:

Abuse of alcohol, coffee.
Long stay in the cold.
The man is hungry.

If measures are not taken in a timely manner, the patient may become unable to work because he cannot perform normal activities. It is especially difficult for a person to write. Compared to the dangerous Parkinson's disease, tremor does not cause dementia, but the ability to think normally remains.

The following main signs of tremor can be identified:

Involuntary head movements.
Hands tremble a little, but when a person begins to worry, his condition worsens.
The tongue trembles; a person can even stick it out of his mouth.
Muscle tone.
The tongue becomes slurred and speech becomes unintelligible.
Trembling increases during times of stress.
Tremor is not observed when the person is asleep.

What is essential tremor?

Essential tremor (ET, synonyms: hereditary tremor, Minor's disease) is a serious disease that is neurological in nature. Manifested by trembling of the hands, tongue, larynx, etc.

In the world, this disease is observed in approximately 3-4% of the total population. Therefore, it is not worth calling the occurrence of this disease a rare case.

The disease occurs most often in people aged 40 years and above. It occurs as a result of disturbances in the interconnections of organs such as the cerebellum, thalamus and brain stem.

Popularly, essential tremor is considered a family disease or, as it can also be called, hereditary diseases.

From the latest work carried out by scientists studying the causes of this disease, it was found that the occurrence of essential tremor is associated with mutational processes in genes such as ETM2, FET1, and ETM1.

But, nevertheless, the problem of the appearance of this disease has not yet been fully studied, and this disease today is a mystery to most doctors and scientists.

Essential tremor: what it is, symptoms and treatment

Essential tremor is a disease of the nervous system with a hereditary predisposition. It is characterized by trembling of the hands, tongue, chin, head, voice, and rarely other parts of the body. May be combined with other symptoms of nervous system damage. It often manifests itself after 30-40 years.

In itself, this disease does not pose an immediate danger, but it can significantly impede social and professional activities. The main drugs for treatment are β-blockers and anticonvulsants; if medication is ineffective, surgical treatment is possible.

Let's find out in more detail what kind of disease this is, what are its main symptoms and how it is treated.

Essential tremor has many synonyms: Minor's disease, familial tremor, hereditary idiopathic tremor, benign, congenital tremor. These terms refer to the same disease. First described back in 1887.

The incidence of essential tremor is 0.5-5.5%. It affects men and women with equal frequency. The older a person gets, the higher the risk of essential tremor.

Thus, in middle-aged people, the prevalence of the pathology is approximately 300-415 per 100,000 population, and after 65 years - 616 per 100,000 population.

1 Reasons
2 Symptoms
3 Diagnostics
4 Treatment
5 Forecast

Symptoms

At the beginning of the disease, tremor occurs when performing any purposeful movements; in later stages, it does not go away even with rest.

The main clinical manifestation of essential tremor is tremors in the hands, which occurs:

when giving your hands a certain posture (for example, stretch your arms straight forward and hold them in that position): postural tremor;
when performing any purposeful movement (for example, touching the tip of the nose with a finger): intention tremor;
at rest: resting tremor.

The most characteristic of this disease is postural and intention tremor. Usually the changes that occur are symmetrical, although the onset of the disease is possible from unilateral localization. At first, tremor appears only with tension or prolonged performance of any work with the hands, but gradually it begins to bother the patient with minor movements and even at rest.

Trembling occurs due to alternating contraction of the flexor and extensor muscles of the fingers and hands. The tremor frequency ranges from 4 to 12 Hz, the vibration amplitude is small. With age, the frequency of tremor may decrease slightly, and the amplitude may increase.

Emotional stress, fatigue, lack of sleep, attempts to suppress trembling by force of will, drinking coffee, strong tea and energy drinks, and staying in the cold only intensify the symptoms. A characteristic symptom is the occurrence of tremor only during wakefulness; during sleep, the tremor disappears.

Alcohol has a special effect on the symptoms of essential tremor.

After taking it for several hours, there is a decrease and even disappearance of symptoms, but the next day they return and sometimes even have a greater degree of severity than before drinking alcohol. This feature can lead to addiction to alcohol and the development of alcoholism in patients with essential tremor.

In addition to the hands, as the disease develops, other parts of the body are involved in the pathological process:

tongue: trembling of the tongue leads to slurred speech (dysarthria);
lips, cheeks, forehead, temples, eyelids (occurs in 60% of patients): it looks like facial twitching;
head (occurs in 50% of patients): nodding, rocking movements like “yes-yes”, “no-no”;
larynx with vocal ligaments (with a history of disease of more than 10 years): manifested by trembling of the voice, changes in timbre, and also leads to blurred speech;
diaphragm: main respiratory muscle. Its involvement in the process may be accompanied by a disturbance in the rhythm of breathing and also leads to peculiar changes in speech (it becomes jerky and incomprehensible);
legs: trembling of the lower extremities occurs only in 20% of patients with a significant history of the disease. Usually not pronounced, at least it does not impede movement.

It usually takes years from the onset of tremors in the hands to the involvement of other parts of the body.

Essential tremor can be combined with other extrapyramidal disorders: parkinsonism, involuntary movements, impaired muscle tone. The tone increases slightly, never reaching the same degree of severity as in Parkinson's disease. The most frequently detected involuntary movements are:

“writer’s cramp”: the inability to use a pen due to severe muscle tension that occurs when the patient picks up a pen or pencil;
blepharospasm: involuntary muscle contractions of the eyelids;
spastic torticollis: forced position of the head in the form of a slight turn and tilt of the head;
oromandibular dystonia: impaired tone of the masticatory muscles with simultaneous grimacing, opening the mouth, and sideways movements of the jaw.

Regarding the age of onset of the disease, several forms are distinguished:

children's;
youthful;
mature age form;
presenile;
senile

Diagnostics

To exclude other causes of tremor, additional examination is performed.

For diagnosis, the type and location of tremor, the slow progression of the disease and its benign quality are important, because tremor does not pose a threat to life, does not reduce life expectancy, but only worsens its quality.

In addition to medical history (including information about the presence of similar symptoms in relatives) and an objective neurological examination, computed tomography (CT) or magnetic resonance imaging (MRI) plays an important role in diagnosis.

These studies are carried out for the purpose of differential diagnosis to distinguish essential tremor from other diseases of the nervous system (Parkinson's disease, torsion dystonia, multiple sclerosis, etc.).

A feature of essential tremor is the absence of pathological changes on CT or MRI. And other diseases will show signs on CT or MRI.

Forecast

Essential tremor is not a dangerous disease at all. Its progression does not pose a threat to the patient, does not affect life expectancy, and does not reduce intelligence. However, symptoms can significantly impair professional skills and interfere with self-care (severe tremor makes it impossible to even eat or dress independently).

It is impossible to completely get rid of the disease, but systematic treatment allows you to reduce the symptoms to a minimum, practically without complicating the patient’s life.

Thus, essential tremor is a disease with which you can learn to live fully. Has a hereditary predisposition. The main symptom is trembling, which depends on many factors. Drug or surgical treatment can reduce all manifestations of the disease to nothing. Therefore, if tremors occur, you should consult a doctor as soon as possible.

on the topic “Essential Tremor is more than a tremor”:

Symptoms of Minor's disease

According to the classification, essential tremor can be divided based on the symptoms that appear in the human body due to this disease.

It comes in the following types:

family type (when symptoms of the disease are observed in one of the parents or both at the same time);
sporadic type (when no manifestations of trembling are observed at the clinical level).

It is necessary to take into account the fact that the occurrence of signs that indicate this disease does not mean the presence of essential tremor in the anamnesis. Therefore, to establish an accurate diagnosis, you need to do a thorough examination of the whole body.

In the form of clinical manifestations, according to the level of severity, this disease is:

minor or intermittent type;
moderate type (when there is an insignificant effect on general well-being and practically no disruption of human functions at the social level);
a pronounced type or obvious (it significantly complicates the performance of daily functions both in everyday life and in society);
severe type or significant (leads to persistent and irreversible disability). Moreover, in this form, treatment of this disease using both medication and folk methods is ineffective.

Symptoms of this disease rarely appear in people at an early age.

Symptoms indicating the appearance of such a disease as essential tremor are not in every case able to manifest themselves at the very beginning of the onset of this disease.

As a rule, in the vast majority of all identified cases, a similar course of symptoms is observed when the cause of essential tremor is mutations in genes.

Main reasons for development

The described disease is the result of pathological changes of a genetic nature, in which chromosomes 2 and 3 undergo mutation processes. And if a gene with a pathological feature has already manifested itself at some point in the family, it will dominate and manifest itself as the described disease in all generations.

You need to know that essential tremor is indicated by varying degrees of severity of its manifestation, for example, trembling can affect only the hands or, conversely, affect different parts of the body.

In some patients, the described defect of a genetic nature cannot be identified, which determines the polygenic coding of the disease.

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Essential tremor in all subsequent generations manifests itself at an earlier age, along with the severe course of the disease itself.

The described pathology is indicated by the following forms of its manifestation:

Familial - with existing signs of a disease recorded in previous generations.
Sporadic – the first occurrence of symptoms of the disease in someone in the family.

Essential tremor can also be indicated by other reasons for its occurrence. The described disease can arise against the background of pathological changes in the interaction of brain structures responsible for regulating muscle activity.

In addition, the described pathology can be caused by:

Parkinsonism.
Hepatolenticular degeneration.
Thyrotoxicosis, hyperparathyroidism (thyroid dysfunction).
Disorders of the liver and kidneys.
Stroke condition.
tumor .
trauma .
Drug intoxication.
Idiopathic dystonia .
Degenerative condition of the cerebellum.

Possible complications of the disease

In most cases, essential tremor leads to disturbances in the functioning of the nervous system and, as a consequence, manifests itself with the onset of old age.

After approximately 40 years of age, people suffering from this disease begin to notice the occurrence of mild twitching of facial expressions and minor disturbances associated with movement and activity.

At the age of 60, previously minor symptoms gradually turn into very strong tremors and distortions of facial expressions.

Types of disease

This disease can affect different parts of the body. In some cases, tremors can significantly complicate the functioning of almost all areas of the body, in others - only one or two areas.

Based on exactly which parts of the body this pathology affects, it comes in several types:

Essential hand tremor (the most common type of this disease, observed in 70% of all cases of this disease). It may be complicated by tremors in other areas of the body.
Leg tremors. This type of essential tremor is observed quite rarely. It can be observed in every 5 people who suffer from a similar illness.
Trembling of the head. It affects approximately 50% of all people who have essential tremor. The symptoms of this type of tremor are very noticeable. When a patient has a head tremor, he begins to move this part of the body quite often and for no particular reason, in some way making a non-verbal affirmation or denial.
Facial trembling. This type of essential tremor manifests itself in the form of periodic contractions of facial expressions. It can be found in half of the patients who suffer from body tremors.
Tremor of the tongue. This type of pathology is extremely rare. Its symptoms are that a person, due to frequent contractions of the tongue, loses the ability to understand, articulate speech.
Diaphragm shake. Because of it, constant trembling and contraction of the main muscle, which is responsible for the breathing process, occurs. This causes incorrect circulation and exit of air from the lungs, which leads to disruptions in the breathing rhythm during a conversation.
Tremor of the larynx. During the onset of this pathology, a person’s voice may change slightly, but at the same time, his speech and pronunciation of words remain more or less understandable.

What does it look like

It all starts with shaking hands. When the pathology actively progresses, muscle contractions in the tongue, chin, cheeks and other parts of the head become noticeable. If we are talking about an advanced stage, then we can note twitching of the muscles of the legs, chewing and respiratory muscles.

Small hand tremors are alternating rapid muscle contractions in the area of the bends of the fingers and hands. With age, the amplitude of contractions increases, but the frequency decreases.

Trembling in the limbs can manifest itself both at rest (rest tremor) and in a certain position, when the hands are in one position or another or a person tries to perform some action, for example, take a pen. Tremor can also be unilateral and symmetrical (this option is more common).

Question answer

Why are your hands shaking?

Causes of Minor's disease

The factors that cause this disease can be of a different nature.

First of all, most doctors believe that essential tremor occurs as a result of a genetic predisposition.

If this disease manifests itself in one of the parents, then it is highly likely to appear in his children.

It has been found that essential tremor begins to manifest itself at much earlier stages of human life. Simply put, this disease becomes younger and younger from year to year and begins to develop in more severe forms.

There are reasons for the appearance of this disease that are in no way related to heredity and the processes of mutations in genes that occur in the human body. These include:

disorders that occur during interactions between different parts of the brain;
Parkinson's disease, which is caused by the death of individual cells in the brain;
disruptions associated with the functioning of the thyroid gland, as a result of which there is a significant increase in the amount of thyroid hormones;
stroke;
the appearance and development of malignant formations in tissues located in the brain area;
failures during kidney function;
severe injuries and bruises to the brain, resulting in damage to certain areas of the brain;
disruptions in the functioning of certain systems in the body due to exposure to chemical or pharmaceutical drugs.

Etiology, pathogenesis

The pathology is hereditary, determined by mutations in the ETM1, ETM2, FET1 genes, and is transmitted in an autosomal dominant manner. Penetrance is incomplete, but quite high; in the heterozygous state, the clinic manifests itself in 80% of offspring.

The disease is equally common among men and women. The disease is common, noted on all continents, the total number of carriers of the pathology is about 4% of the population.

Pathogenesis consists of disruption of the interaction of the structures of the cerebellum, thalamus, and brainstem nuclei. Hyperkinesis develops due to an imbalance between the functioning of the adrenergic and cholinergic systems, hyperfunction of adrenergic elements. As a result, contractions occur in the muscles of some areas of the human body with a frequency of 5 - 15 Hz.

Diagnostics

It is very difficult to diagnose tremor in such areas of the body as the diaphragm and vocal cords.

Also difficult is the determination of essential tremor of the tongue. This is due to the fact that these types of essential tremor occur without the presence of pronounced symptoms, or the manifested symptoms of these diseases are so insignificant that they are practically invisible.

Therefore, it is necessary to seek medical help in the case when, for no particular reason, a person begins to experience a change in voice or some distortions in speech.

Essential tremor has one specific feature. Its manifestation is that trembling bothers a person only during activity and wakefulness. During sleep, all symptoms of this disease completely disappear.

The occurrence of this disease in humans can be identified through diagnostics, which involves the following procedures:

Thorough examination and interview of the patient. During the first visit, the doctor interviews the patient and tries to determine as accurately as possible the type and type of essential tremor, trying to identify the possible causes of its occurrence.
Conducting a neurological examination. This diagnostic stage involves carrying out certain procedures that are necessary to determine the condition of the patient’s muscles and nerves.
Carrying out instrumental diagnostics. At this stage, computed tomography and magnetic resonance imaging are used, which are necessary for a thorough study of various areas in the brain. These measures are carried out only when the possibility of hereditary essential tremor is completely excluded.

Diagnostic methods

Usually, to make a diagnosis of the described disease, doctors collect data from the patient’s medical history and detailed aspects of the manifestation of ET in the form of a definition:

vibration frequencies and amplitudes
laboratory studies of a sick person;
tendency to drink alcoholic beverages;
tone ;
existing posture .

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To identify the described diagnosis, differential diagnostics is used using hardware examination methods in the form of:

Magnetic resonance imaging.
Computed tomography.
Angiography.
Electroencephalography.
General and biochemical blood tests.
Genetic examinations .
X-rays.

All of the above examination methods are necessary for medical workers to exclude other pathologies in patients associated with damage to the nervous system, for which tremor is a characteristic symptom.

Treatment of essential tremor

The treatment of essential tremor can be either medicinal or surgical.

Surgeons intervene only when drug treatment is completely ineffective and there is a constant deterioration in the patient's health.

In addition, the treatment of essential tremor can be carried out using folk remedies, and, as many claim, the therapy method is very good for alleviating the disease.

In the case of surgical intervention, a patient who suffers from essential tremor undergoes destruction of the ventrointermediate nuclei of the thalamus.

This operation allows for a significant reduction in tremor. But it is necessary to take into account the fact that the consequences of such surgical intervention are irreversible.

Pharmacological methods used to treat this disease include:

taking beta-adrenergic receptor blockers, which can reduce essential tremor of the hands and head;
vasoconstrictor drugs, which are sodium channel blockers (they have a positive effect on the condition of a patient who has essential hand tremor);
primidone, which is used to reduce the severity of manifestations of the clinical type of this disease.

When a person develops essential hand tremor, it is possible, as already written above, to be treated using folk remedies.

However, it should be noted that it will not completely get rid of this disease, but will only alleviate the course and symptoms that arise during the onset of this disease.

The most common and at the same time easiest to use folk remedy is the use of a flower called tansy. When a person has an essential tremor of the hands, several peas of these flowers are taken for therapy, then they are chewed, while the saliva that is released must be swallowed, and the cake formed during the chewing process must be spat out.

Motherwort tea is very popular in folk medicine for the treatment of this disease.

To prepare it, take only two teaspoons of dried herbs and pour it into a container with boiling water. Next, the resulting decoction is given time to brew and taken in equal portions throughout the day.

Also, when a person develops this disease, physiotherapy is actively used for treatment. It is a specially developed exercise therapy complex, the implementation of which can reduce trembling in the hands or head.

Physiotherapy also involves doing special gymnastics and performing specially designed exercises that are necessary to maintain hand function.

Essential tremor: symptoms and effective therapy

Causes

Most often, the main cause is hereditary predisposition. The disease is transmitted from parents to baby. There is almost a 50% chance that if a person suffers from essential tremor, he will have a child with the same pathology.

The disease can occur at any age, but it is often diagnosed in older people. Poor blood circulation in the brain can lead to the development of tremor. The brain stem, red nuclei, and cerebellum may not interact properly, causing the nervous system to malfunction.

Trembling may be neurotic in nature.

There are also a number of other reasons that provoke the development of the disease. This could be Parkinson's disease, which causes brain cells to die. Thyroid dysfunction. It may be either a deficiency or an excess of hormones. Consequences of diseases of the biliary tract and liver. Stroke and various tumors in the brain also cause the development of the disease.

Intoxication of the body with drugs leads to pathology. Bruises and brain injuries can provoke not only essential tremor, but also other diseases. In order to avoid any negative consequences, it is necessary to consult a doctor in a timely manner. A neurologist will be able to make an accurate diagnosis and prescribe comprehensive treatment.

Diagnostics

First of all, the neurologist collects the necessary information about the disease. It will also find out when the symptoms began to bother you, and whether they may be hereditary. Examines the patient's medical record and various chronic pathologies, if any. The specialist must listen to all the patient’s complaints and conduct a neurological examination.

The doctor should refer you for consultation to various specialists, if necessary. The neurologist also checks muscle tone for resistance. Examine all parts of the body for tremors. The specialist must know whether the patient drinks alcoholic beverages.

MRI and CT scans are also performed ; this will help identify various pathologies that are associated with the brain. The procedure is often done with a contrast agent, but a test must be performed before this, as there may be an allergic reaction to the contrast. The study is also done on young children and pregnant girls.

X-rays and electroencephalography may be prescribed. In rare cases, a specialist will refer you for examination of blood vessels in the brain. It is best to consult a doctor promptly, as complications may occur.

What are the types of essential tremor?

There are several types of the disease, and each manifests itself differently. It is worth paying attention to how intense the symptoms appear. This will help avoid serious complications. You should not ignore the symptoms; the sooner treatment for essential tremor is started, the easier it will be to eliminate it.

There are several types of pathology:

Essential hand tremor is observed in many patients. With this type, muscle contraction occurs during flexion and extension of the limbs. Often this becomes the main symptom of the development of the disease. A person begins to feel a tremor when performing any actions with his hands. At the initial stage, the disease may not manifest itself so clearly. Trembling at rest can occur in older people over 60 years of age.

Essential head tremor is observed in almost half of patients. This also happens to be the first manifestations of Minor's disease. Tremor manifests itself as shaking or nodding of the head.
About 60% of people suffer from tremor of facial muscles. The patient experiences tremors in the lips when talking or smiling. Muscle twitching may occur in a calm state. This indicates that the first symptoms of the disease are appearing.
Tremor of the eyelids and tongue occurs less frequently. The symptoms appear almost imperceptibly, but the patient feels it vividly.
One third of patients who have had the disease for more than ten years may experience tremor of the ligaments. Some patients at a young age may also experience similar changes. The voice changes greatly, and speech becomes slurred. The patient may eventually notice that stuttering occurs.

Tremor of the diaphragm is observed very rarely and manifests itself specifically. An accurate diagnosis can only be made with an x-ray. There is a disturbance in the respiratory system, and speech becomes unintelligible.
Leg tremors occur in one quarter of patients. A person may not feel any changes, and at first glance nothing is visible. In order to confirm the presence of the disease, it is necessary to conduct an examination.

If the patient notices any manifestations, then you should immediately visit a neurologist. Only he will be able to make an accurate diagnosis and prescribe the correct treatment. It is not recommended to self-medicate, as this may worsen the patient's condition. Even with small signs, it is best to play it safe and seek help from a doctor.

ethnoscience

Many people do not know how to treat essential tremor using traditional methods. Natural remedies give positive results if combined with medications.

Sage calms a person well and improves sleep. You need to take a few spoons of the crushed plant and add hot water. Pour the broth into a thermos and leave to steep for eight hours.

After this, strain the product and take a teaspoon several times a day with milk.

You can take a warm bath from the same infusion. You will need to buy sage at a pharmacy and fill the whole pack with hot water. Strain the product and pour into the bath; the procedure is carried out for at least twenty minutes. You can make a tincture from motherwort, heather, valerian root and dried cucumber. Mix all ingredients and pour hot water over the contents. Pour into a thermos and leave for ten hours to allow the product to infuse. It must be taken orally throughout the day.

For the next recipe you will need hawthorn, valerian tincture and dry motherwort. You need to combine all the ingredients and add hot water. You will need to consume a tablespoon several times a day. You need to know that the drug has a strong sedative effect. You need to take chamomile and mint, add water, put on fire and cook for about 20 minutes.
It is necessary to leave the resulting product for several hours so that it infuses well. You need to take a whole glass several times a day before meals. This tincture has a calming effect and reduces excitability. If you use folk remedies and medications together, the treatment will proceed faster.

Essential tremor is best treated in the early stages of development. If the pathology is advanced, then surgery will most likely be needed. The specialist first conducts a comprehensive examination and only then makes an accurate diagnosis. The doctor often prescribes physiotherapeutic procedures, because they help to quickly overcome the disease. Unfortunately, essential tremor cannot be completely cured, but tremors can be reduced. For this purpose, special preparations are used. They should only be prescribed by the attending physician, as they have side effects.