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ESSENTIAL TREMOR (HIGH HANDS)

Updated: Jun 2, 2022



TREMOR

Tremor: It means tremor in Turkish. It is a movement disorder that occurs with short-term contraction of the muscles. It is frequently seen in Turkey and all over the world. Not every tremor (tremor) is a symptom of disease. There are also physiological tremors, that is, tremors that are not related to a pathology in the brain, and they are seen quite frequently (4%) over the age of 40. It is one of the most common movement disorders.




essential tremor; It is also known as benign, familial or hereditary tremor. It is among the most common movement disorders. It begins in adulthood and progresses with aging. It is in the form of postural and kinetic tremor. That is, they occur in a certain position (when the hands are extended forward) or during movement (while holding a glass, spoon or writing). It is most common in the hands. Then it occurs in the head and neck, legs, voice (larynx) and trunk. They generally do not initially affect the patient's daily work. However, in the future, it can become a situation that seriously affects the quality of life, mostly in hyper-adrenergic conditions (excitement-stress). The tremors of people with tremor increase in cases of stress, insomnia and excessive caffeine consumption. The patient does not have any other neurological symptoms. There is no pathology in imaging methods and blood analysis. Shivering can sometimes occur in thyroid dysfunctions. These types of tremors are usually hereditary.




It is necessary to distinguish essential tremor from Parkinson's disease tremor. The incidence of essential tremor is 10 times more common than Parkinson's disease. Parkinson's tremor is static tremor. Contrary to essential tremor, it occurs at rest, when the hands are in a relaxed position, and decreases with movement. There are other neurological findings that are not seen in patients with essential tremor in Parkinson's disease. These are findings such as slowing down in movements, walking with small steps, walking with the head and trunk tilted forward, decrease in facial expressions, stiffness in the muscles we call rigidity.




Although it is not as frequent as essential tremor, one of the tremors that should not be confused is cerebellar (in cerebellar lesions) tremor. It is a kinetic (occurring with movement) tremor like essential tremor. It is more severe than essential tremor. The tremor increases as the hands get closer to the target. As the glass gets closer to the mouth, it increases and starts to pour out while drinking the full water. In addition, patients with cerebellar pathology may have other examination findings such as instability while walking and sitting, which are not seen in essential tremor.




ET does not shorten your lifespan. The tremor may increase over time, but change is usually slow and occurs over years. As a result, some patients may experience some disability, such as difficulty in writing, eating and drinking, and even social embarrassment. Mild tremors do not need to be treated, and early treatment does not stop or slow the natural course of the disease.




Treatment of essential tremor; If tremors reduce the patient's quality of life, drug therapy is started when he begins to have difficulty performing daily activities. Propranolol is one of the most used drugs. However, care should be taken to ensure that the patient's blood pressure and pulse are not low. Another drug is primidone; It is an anti-epileptic drug. It is necessary to start with very low doses and increase. Drugs such as benzodiazepine, gabapetin, topiramate are also used. In addition, botulinum toxin injection can be applied to the affected muscle groups. It has been observed that it is more effective especially in head-neck tremors. There are surgical treatment methods for patients with severe tremor who cannot get results with drug therapy. These are:




• Thalamatomy; It is a brain surgery performed by damaging the thalamus region of the brain.


• Deep brain stimulation (DBS); In another thalamus surgery, a wire called an electrode is placed in the thalamus area and connected to a battery-like device that is placed under the skin on the chest.

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