Psychology and Psychiatry

Essential tremor

Essential tremor - this is the pathology of the nervous system. The described ailment itself does not pose a direct danger, however it can deliver countless unpleasant moments in social life, substantially complicate professional activities and make daily life difficult.

Essential tremor, what is it, unlike other types of tremor, its manifestation? These questions interest many. Its main symptom, as well as other variations of tremor, are muscular oscillatory contractions of an involuntary nature. The difference lies in the etiology. As a rule, the pathology in question is caused by a gene mutation (the second or third chromosome) and is inherited according to an autosomal dominant trait, in other words, the disease does not depend on gender. Basically, this violation begins to manifest itself after thirty years of age. Most often, there is trembling of the hands, less frequent is an essential tremor of the head, jaw, eyelids, and the trunk tremor is most rarely observed. This type of tremor is often combined with a different clinical symptomatology of various pathologies of the nervous system.

Causes of Essential Tremor

To find out the reasons provoking this disease, it is necessary to determine the essential tremor that it is. Tremor is called oscillatory contractions of the muscles of the upper and lower extremities, less often the head, torso, neck.

The term essential tremor is applied to an ailment that is not triggered by external causes.

The causes of the development of essential tremor are not fully understood. Scientists say that in about fifty cases out of a hundred, this type of tremor is due to a gene mutation. In other words, this type of shake can be attributed to hereditary diseases. Often, in a single generation, the number of patients exceeds the fifty percent threshold. If both parents suffer from the disease in question, then the number of cases in the first generation reaches almost seventy-five percent. In addition, there are also isolated (sporadic) cases of the development of essential jitter, the causes of which remain unexplained.

This type of pathology appears regardless of gender and age, as it is due to genetic predisposition. However, it is more often observed in people of more mature age.

Another cause of the disease in question can be considered a violation of the interaction of individual brain structures (red nuclei, cerebellum and brain stem), which are responsible for regulating the arbitrary activity of the muscles.

More often, small and medium muscle contractions of the limbs, especially the upper ones, are found. With this type of tremor there is no increase in muscle tone. Trembling occurs as a result of alternate muscle contraction of the flexors and extensors. Shivering becomes more pronounced with purposeful actions of a person, whereas at rest essential tremor is almost not noticeable in young people under sixty-60 years.

Also this species tremor may provoke the following diseases: hyperthyroidism, Parkinson's disease (due to gradual dying brain cells), hepatolenticular degeneration, kidney or liver failure, stroke, tumor growths in the brain, head trauma, cerebellar degeneration, intoxication drugs, idiopathic muscular dystonia .

Symptoms of Essential Tremor

The type of disease in question is also known as Minor’s disease or familial (hereditary) tremor. This type of tremor has a neurological nature.

The following are typical signs of essential tremor. In the first turn, tremor characterizes the appearance of a slight tremor in the upper limbs, head or legs. Such a shake can be observed both in a relaxed state of the body, and when performing minor actions, for example, when trying to write something or fasten a button. Symptomatology is more pronounced with targeted specific movements.

Another frequent symptom of essential tremor is trembling of the tongue. This symptom is considered characteristic of the disease in question. Often, trembling in the tongue is detected only during a medical examination, since the patients themselves or their relatives do not notice it.

Unreasonable head movements (like nods), reminiscent of children's reactions to simple questions that require an unequivocal or negative answer "no", or an affirmative nod, implying "yes", are also a symptom of family tremor.

Another sign of essential tremor can be a change in timbre of the voice, manifested by a feeling of vibration unrelated to anxiety or excitement.

However, the most characteristic symptom of this pathology is trembling of the upper extremities of small or medium amplitude while maintaining muscle tone unchanged.

Tremor covers the joints of the fingers and wrist joints. This type of tremor is a muscular contraction of a rhythmic nature. At the beginning of the development of the pathology under consideration, essential tremor occurs only when performing some action. In the future, the disease may appear spontaneously at rest. Over time, there is a decrease in the frequency of oscillations and an increase in amplitude.

Signs of essential tremor, in addition, consist in intensifying trembling during emotional overloads, exposure to stressors, communicative interaction with people, physical fatigue, drinking alcohol-containing liquids or drinks containing caffeine, feeling of hunger, hypothermia, and being in public places. Over time, due to an increase in symptoms, a person loses working capacity, since the ability to perform basic actions (for example, to thread a needle through a needle) is impaired. Especially the complexity of such a patient delivers the letter.

A characteristic difference in family tremor from parkinsonism is the lack of dementia or a deterioration in the ability to think. The listed symptoms with age tend to increase. You can also select a number of related physiological tremor symptoms:

- pathological position of the head or spastic torticollis;

- unintentional contractions of the circular muscles of the eye (blepharospasm);

- reduction of chewing muscles (oromandibular dystonia).

Symptoms of the disease under consideration depends on its location. Depending on the place of jitter, hereditary tremor can be classified as follows:

- physiological tremor of the hands (it should not be confused with shaking hands, caused by Parkinson's disease or due to age-related dysfunctions of the musculoskeletal system);

- trembling of mimic muscles, which is characterized by oscillatory contractions of the labial muscles that occur spontaneously when talking or smiling, can also tremble temporal muscles and cheeks;

- physiological tremor of the eyelids and tongue (occurs less frequently than other types of tremor, and may be almost invisible to others, but are well felt by the person himself;

- the quivering timbre of the voice may be present in the vocal cords, which are responsible for speech functioning, which leads to the transformation of the timbre of the voice (the patient's voice is made trembling, as if bleating, vibrating, besides, there may be stuttering and difficulties with clear and precise pronunciation of words) develops mainly in elderly patients, especially if the duration of the disease is ten or more years;

- A rare type of pathology is considered to be a shake of the diaphragm, which can be determined by X-ray method (a combination of tremor of the diaphragm, trembling of the tongue, voice, and lips causes specific changes in speech (made abrupt, illegible and difficult to understand) and breathing (becomes intermittent);

- physiological tremor of the legs is also rarely observed (approximately in twenty percent of cases), often its manifestations are inconspicuous or poorly expressed, therefore, they can be diagnosed only with the help of hardware examination;

- Essential tremor of the head is caused by involuntary synchronous oscillatory contractions of the muscles of the neck and face, can be expressed in the form of single or multiple (head tilt up and down, side-to-side winding) nods of the head or a steady shudder of the head.

Also, physiological tremor can be systematized depending on the severity of symptoms. Hereditary tremor can occur:

- easy or present stages;

- moderately;

- expressed, delivering to the patient a serious physical inconvenience and psychological discomfort, which significantly affects the human performance;

- significantly, not allowing the patient to perform daily household activities and interfering with normal life activity.

Treatment of essential tremor

Before treating essential tremor, it is necessary to make a thorough differential diagnosis in order to exclude other pathologies for which tremor is a characteristic symptom. It is necessary to exclude the following diseases:

- dystonia;

- multiple sclerosis;

- Parkinson's disease;

- neurotic tremor;

- toxic lesions;

- alcohol addiction;

- encephalopathy on the background of liver failure;

- A number of other pathologies.

In the first turn, at statement of the diagnosis it is necessary to turn on the following signs:

- frequency of tremor;

- jitter amplitude;

- analysis of the patient's pedigree;

- muscle tone;

- posture of the patient;

- tendency to abuse alcohol-containing liquids;

- concomitant symptoms.

In addition to the external examination for the examination of the patient, various laboratory tests and hardware techniques are used:

- magnetic resonance imaging and computed tomography;

- genetic research;

- Electroencephalography is performed to establish the electrical activity of the brain;

- angiography is performed to investigate the state of the capillaries of the head;

- X-ray examination;

- biochemical and complete blood count.

How to treat essential tremor? Today, there are drugs that are aimed at slowing the progression of symptoms of hereditary tremor and reducing their severity. It is necessary to understand that, despite the relatively slow increase in trembling, the treatment of essential tremor is necessary, since this pathology in people in more mature age can give rise to serious problems in everyday life. Trembling can quickly progress in old age, which leads to the inability to self-maintain.

Familial tremor, like most pathologies with a neurological etiology, is treated comprehensively, therefore, the use of drug therapy and non-drug effects, as well as surgical intervention, as necessary, is practiced.

Drug therapy involves the use of the following groups of drugs: beta-blockers, anticonvulsants, tranquilizers of the benzodiazepine group, group B vitamins, as well as the intramuscular administration of small doses of Botox.

Beta-blockers of adrenoreceptors are a group of pharmacopoeial drugs, due to the introduction of which the body blocks adrenergic receptors that react to adrenaline and noradrenaline, resulting in a decrease in the severity of symptoms (Propranolol, Primidon, Anaprilin). Drugs in this group contribute to a significant reduction in the amplitude of the jitter. It is necessary to apply long courses under control of indicators of arterial pressure and pulse as drugs of this row can promote decrease in indicators of pressure and pulse rate.

Anticonvulsants (Clonazepam, Gabapentin, Primidon) are used to eliminate shaking. In this case, treatment with drugs of this series should be carried out over the years with short intervals. The dose should be selected step by step and slowly. This is due to the appearance of drowsiness and general weakness at the start of anticonvulsant therapy. Upon further admission, if the dose titration is carried out correctly, then all unpleasant sensations disappear.

Benzodiazepine tranquilizers (Diazepam, Oxazepam) are prescribed for the enhancement of essential tremor, which occurs as a result of chronic anxiety states.

It is believed that with hereditary tremor, gradual inhibition of the progression of symptoms is promoted by large doses of vitamin Pyridoxine, used intramuscularly. Its positive result is due to the effect on serotonin metabolism. Assign vitamins B6 monthly courses (usually about two times a year).

The administration of small doses of Botulinum toxin (Botox) is practiced with tremor of the head and voice tremor. Usually the duration of treatment is approximately six months. Injection of Botox type A reduces the amplitude of oscillations during physiological tremor. The introduction of botulinum toxin (dosage 50 U) in the ulnar flexor of the hand leads to a decrease in the severity of the tremor (by more than thirty percent) in approximately forty percent of patients. Some medical scientists suggest applying higher doses (up to 100 U in each muscle). According to a number of studies, the introduction of Botulinum toxin helps to reduce, in most cases, kinetic tremor, and the manifestations of postural tremor are less affected. A side effect in the form of a sensation of weakness in the upper extremities from low-dose injections is detected in approximately thirty percent of patients and practically in seventy percent of patients with high doses. When trembling the head, Botulinum toxin is injected into stratospheric and stern muscles. The dosage ranges from forty to four hundred units. When voice tremors his dose is from 0.6 to 15 units. Side effects of botulinum toxin treatment are voice hoarseness and respiratory dysfunctions.

The atypical anticonvulsant (pharmaceutical drugs with anticonvulsant action and used, as a rule, to relieve seizures of various etiologies, treatment of epilepsy) is considered to be the newest promising treatment for physiological tremor, a Pyrrolidone derivative, quite close to the nootropic Piracetam. The results of studies of the effectiveness of Levetiracetam in the treatment of essential tremor indicate high efficacy rates - in most patients the trembling has decreased significantly, regardless of its location. In addition, there are no serious side effects with proper dosage calculation.

Non-drug treatment of essential tremor includes methods of physiotherapy, gymnastic exercises, and contrasting souls.

Among the effective physiotherapeutic methods can be distinguished physical therapy, which aims to restore control of the muscles, and in the presence of trembling of the diaphragm - the formulation of proper breathing.

Hand shaking can be partially eliminated by manipulating small objects and gymnastics for fingers. The main condition for efficiency, in this case, is the regularity of classes. Various balneological procedures, especially contrasting souls in the conditions of sanatorium-and-spa treatment, help well with this ailment. It is also not superfluous to follow a special diet, acupuncture and relaxing massage, acupuncture.

In severe cases of disease progression, when traditional conservative treatment does not produce results and a healing effect or due to certain reasons cannot be prescribed (for example, if you are allergic to drug components, serious liver, kidney or stomach diseases), surgical intervention is recommended.

Operations can be divided into 2 types: the destruction of the brain area, which is responsible for the interaction between the remaining zones (thalamic nuclei) and neurostimulation of the brain, which consists in the introduction of electrodes that are connected to a device that produces electrical impulses aimed at stimulating the nervous system. The result of brain neurostimulation is either the complete disappearance of the tremor, or a significant reduction in its severity.

In the treatment of essential tremor, you can also use traditional medicine, which include bee venom therapy, leech therapy (hirudotherapy) and herbal medicine. Traditional methods give a temporary result and should be applied only under the supervision of a specialist. Также для расслабления мускулатуры можно практиковать занятия восточными практиками самоконтроля и расслабляющий аутотренинг.So, for example, yoga-mudra can significantly ease the state. This Indian gymnastics uses various combinations of finger positions to harmonize the flow of internal energy flows in the body.

The main and only complication of the pathology in question is the loss of human self-care skills and working capacity. Measures of prevention of this disease in the case of hereditary genesis does not exist. In this case, genetic counseling for patients planning to acquire offspring can play a preventive role. In addition, the progression of the disease can be prevented by avoiding stress and by limiting the consumption of various stimulants, such as alcohol, tea or coffee.