In essential tremor, tremors occur when one is actively using the affected body part rather than when at rest. It most often affects the hands and can be triggered or worsened by stress.
Essential tremor affects up to 10 million Americans, making it difficult, or even impossible, for some to perform such otherwise simple tasks as using a fork or buttoning a shirt. For many of these patients, treatment options may offer some relief.
“Treatment depends on the patients’ symptoms, impairment and quality of life,” says neurosurgeon Nader Pouratian, MD, PhD, director of the UCLA Neurosurgical Movement Disorders Program. “We initiate treatment when tremors start interfering with the patient’s ability to function. This threshold varies depending on the individual.”
In essential tremor, tremors occur when one is actively using the affected body part rather than when at rest. It most often affects the hands and can be triggered or worsened by stress. Essential tremor tends to run in families; about half of all cases are hereditary.
Medication is the first line of treatment. Primidone, an anti-seizure medication, and propanolol, a medication for high blood pressure, often prove effective in treating tremor symptoms, Dr. Pouratian says. In some cases, surgery may be necessary. Dr. Pouratian likens deep brain stimulation (DBS), the most common surgical treatment for essential tremor, to “a pacemaker for the brain.” It involves implanting an electrode in the thalamus, located deep in the brain. When turned on, the electric charge interferes with the part of the brain responsible for the shaking.
“We most often perform DBS while patients are awake in order to ensure the best placement of the electrode and to see that the tremor is reduced,” Dr. Pouratian says. He reports that DBS can achieve a 50-to-80 percent reduction in tremors.
“The effects of this surgery can be dramatic,” he says, explaining how people who use their hands for intricate work, for example, can resume their careers after undergoing DBS. Dr. Pouratian notes that advanced imaging techniques now allow patients to have the option of undergoing DBS under general anesthesia. This option opens the door to patients who may be too anxious to remain awake during surgery.
Radiosurgical thalamotomy, a less frequent treatment for essential tremor, uses radiation to target and eventually create a small lesion in the affected area of the brain. The lesion, like deep brain stimulation, interrupts the faulty brain signals. Thalamotomy generally is limited to patients who are too sick or frail to undergo DBS surgery.
In early 2019, UCLA will begin offering a new way to treat essential tremor using a method recently approved by the Food and Drug Administration: MR (magnetic resonance)- guided focused ultrasound therapy. The approach uses ultrasound instead of radiation to heat and destroy the affected tissue without harming adjacent tissue.
“One of the strengths of our program is that we offer the entire array of treatments, so we’re not wedded to one treatment or another,” Dr. Pouratian says. “Our neurologists and neurosurgeons work together so we can truly find the best treatment for each individual patient.”