He Essential tremor ( TEA T the Essential tremor ( ET ) Is the most common movement disorder in adults. It is a neurological disorder that often has a hereditary origin (Jhons Hopkins Medicine, 2016).
This alteration also receives or has received other denominations in the scientific and medical literature: Benign tremor , Family tremor or Essential tremor (International Essential Tremor Foundation, 2015).
At the clinical level, it is characterized by the presence of tremor in hands and arms during voluntary movement, although it may also appear in the head or voice (Labiano-Foncubierta and Benito-León, 2013).
Tremors usually appear when the affected person performs a voluntary action such as eating, drinking or writing (kinetic or action tremor). In addition, it can also occur when adopting different postures: extend arms or legs outward, among others (postural tremor) (International Essential Tremor Foundation, 2015).
Tremors are one of the symptoms commonly referred to in medical neurology services, however, concrete estimates of the prevalence of essential tremor vary considerably between countries (Labiano-Foncubierta and Benito-León, 2013).
In addition, tremors at the postural level or voluntary movements may present other types of alterations, such as cerebellar motor deficits, cognitive, behavioral and sensorial alterations (Labiano-Foncubierta and Benito-León, 2013).
Although there is no definitive cure for essential tremor, it is not a potentially normal neurological condition. Pharmacological prescription is often recommended for symptomatic treatment and physical therapy to reduce tremor and improve muscle control (National Institute of Neurological Disorders and Stroke, 2013).
What is the tremor essence or essential tremor?
Essential tremor is a type of disorder that affects the nervous system and produces rhythmic and involuntary jolts. Although it can affect any part of the body, it is more common to be present on the hands and arms (Mayo Clinic, 2016).
Although this alteration does not endanger the life of the person who suffers from it, the essential tremor is progressive disorder that has to worsen with time (Mayo Clinic, 2016).
In many cases, essential tremor is underdiagnosed as it tends to be confused with parkinsonian, psychogenic or dystonic tremor (Orphanet, 2011).
About us
Essential tremor is the most common movement disorder. The prevalence of this pathology has been estimated at 2-4% (Orphanet, 2011).
The International Essential Tremor Foundation (2012) has pointed out that the essential tremor affects approximately 10 million people in the United States.
Specifically, over 80% of cases of essential tremor are considered to have a genetic and hereditary origin (Orphanet, 2011).
Essential tremor is present in about 4% of people aged 40 years or older, and possibly in 20% of older people over 95 years of age (Louis, 2010).
This movement disorder can appear and develop at any age, however, it is more prevalent in people over 40 years of age (Mayo Clinic, 2016).
symptom
Tremors are involuntary and rhythmic muscular movements that occur with swaying or oscillations of different parts of the body. Tremors are the most common involuntary movements and can affect the arms, face hands, vocal cords, trunk, and legs (National Institute of Neurological Disorders and Stroke, 2012).
In the case of essential tremors, these refer to the occurrence of a rhythmic and involuntary movement of the hands and arms, especially and that is usually manifested when it is a matter of executing an action or when adopting a specific posture or position Orphanet, 2011).
Therefore, the most distinctive features of the essential tremor are (Labiano-Foncubierta and Benito-León, 2013):
- Kinetic tremor : Involuntary, rhythmic and uncontrolled movement that occurs when the person tries to perform a voluntary movement such as writing or eating.
- Postural tremor : Involuntary, rhythmic and uncontrolled movement that occurs when the person tries to adopt a specific posture.
Although the tremor usually affects both hands and feet, it is possible that one side is more affected than the other. In addition, in some cases the head and legs may also be affected (National Organization for Rare Disorders, 2015).
In general, tremors are characterized by (Mayo Clinic, 2016):
- Insidious start on one side of the body.
- Worsen with movement.
- Preferably affect hands.
- May include movements in the head of?? yes-no??,
- They can worsen with emotional stress, fatigue, caffeine or extreme temperatures.
Approximately 90% of the cases of patients with essential tremor present an initial clinical course characterized by tremor in the upper limbs, affecting by 41%, by 18% the voice, 14% lower limbs, 7% The mandible and less frequently to the trunk and tongue (Bermejo Velasco, 2007).
On the other hand, some people describe the presence of"inner tremors", a general shaking sensation of the body. In more severe cases, resting tremor also appears when the body is relaxed (National Organization for Rare Disorders, 2015).
The tremors are progressive, have to worsen over time, the rate of progression has been established at 1.5-5% each year (National Organization for Rare Disorders, 2015), resulting in a significant disability in carrying out activities of Daily life, eating, writing, grooming, driving, etc. (Louis, 2010).
In addition to involuntary movements, patients may present a wide variety of alterations including (Labiano-Foncubierta and Benito-León, 2013):
- Ataxia : Motor coordination deficit.
- Disdiadococinesia : Difficulty or inability to perform alternating movements in an accelerated manner.
- Oculomotor alterations .
- Alteration of the attention level, ejetuvia function, memory, verbal fluency .
- Alterations related to insane processes .
- Behavioral changes : Alterations in the personality, Depressive symptoms , Anxiety.
- Sensory disturbances Hearing loss (Functional hearing loss).
All this symptomatology is associated to a wide variety of social and psychological consequences. In addition, deficits and difficulties in carrying out routine activities may affect quality of life general. Often affected people avoid social or stressful situations (National Organization for Rare Disorders, 2015).
Causes
Although it has been shown that the occurrence of essential tremor is associated with an abnormal functioning of the cerebellum, it has not been possible to confirm the occurrence of specific anomalies in this structure (International Essential Tremor Foundation, 2015).
In addition, more than half of the cases have been associated with the presence of a genetic mutation, when this happens, the essential tremor is called family or hereditary tremor (Mayo Clinic, 2016).
It seems to be that the essential tremor is an autosomal dominant disorder, so each child of an affected person has a 50% chance of inheriting it (International Essential Tremor Foundation, 2015).
In spite of this, not all the people who inherit genes related to the essential tremor end up developing this alteration. This suggests a possible contribution of environmental factors (International Essential Tremor Foundation, 2015).
Risk factor's
Some risk factors associated with the suffering and development of essential tremor have been identified:
- Genetic alterations : There is a genetic component associated with essential tremor, although no abnormalities have been reported in specific genes (Mayo Clinic, 2016).
- Age : The condition of essential tremor is more common in people who are over 40 years of age (Mayo Clinic, 2016).
Differences between essential tremor and parkinsonian tremor
Within the wide range of neurological symptoms, the development of tremors is usually associated with the Parkinson's disease , However, these are two different clinical conditions (Mayo Clinic, 2016):
- Moment of occurrence of tremors : In the essence tremor, involuntary movements usually occur when a voluntary movement is performed, whereas in Parkinson's disease tremor is associated with states of rest.
- Associated Conditions : In general, essential tremor does not usually cause severe symptoms in other areas. In Parkinson's disease it is associated with a severe motor deficit.
- Affected body areas : In essential tremor the most affected areas of the body are hands, head and voice, while in Parkinson's disease, tremors begin in the hands and expand to the legs and other parts of the body.
Diagnosis
The procedure followed for the diagnosis of essential tremor is eminently clinical (Labiano-Foncubierta and Benito-León, 2013):
When a patient visits a health care facility with tremors, a detailed physical examination and a full history (Labiano-Foncubierta and Benito-León, 2013) are essential:
In addition, other specific diagnostic tests may be used to rule out other primary pathologies.
Although there are no unified criteria for issuing the diagnosis, the Tremor Investigation Group has pointed out the following points (Bermejo Velasco, 2007):
- Definite essential tremor : It is a bilateral postural tremor, observable and recurrent in the upper limbs, without presenting Neurological disorders , Physiological, psychiatric or pharmacological treatments that can explain it.
- Essential tremor likely : In addition to the characteristics of definitive essential tremor, it may affect other areas of interest and be related to the execution of finished activities. It can be transient.
- Essential tremor possible : This is a postural tremor that is not related to significant neurological conditions.
Treatment
When tremors are mild or do not cause functional discomfort, many patients choose not to take any therapeutic intervention. On the other hand, in other patients, tremors are an important source of functional disability (Jhons Hopkins Medicine, 2016).
For the symptomatic treatment of this pathology there are both non-pharmacological and pharmacological approaches.
Non-pharmacological treatment (Jhons Hopkins Medicine, 2016)
Physical therapy, especially that aimed at muscle control, usually reports numerous benefits. Patients report relief of symptoms and improvement of their overall functional level.
In addition, Relaxation techniques or the Biofeedback May be useful for managing stress and anxiety situations, which typically worsen the symptoms of essential tremor.
In addition, reducing the consumption of some substances that increase tremors (coffee, alcohol, etc.) is essential.
Pharmacological Treatment Jhons Hopkins Medicine, 2016)
The drugs used in the treatment of essential tremor are usually adrenergic blockers or anticonvulsive drugs:
- Primidone
- Propranolol
- Benzodiazepines
- Botulinum toxin injections
References
- Clinic, Mayo. (2016). Essential tremor . Retrieved from Mayo Clinic: mayoclinic.org.
- Healthline. (2016). Essential tremor . Retrieved from Healthline: www.healthline.com.
- IETF. (2015). Essential tremor . Retrieved from the International Essential Tremor Foundation: essentialtremor.org/about-et/.
- Labiano-Fontcuberta, A., & Benito-Leon, J. (2013). Essential tremor: an update. Med Clin (Barc)., 40 (3), 128-133.
- Louis, E. (2010). Essential tremor: a cerebellar degeneration disorder? Rev Neurol, 50 (1), 47-49.
- NIH. (2013). Essential Tremor Information Page . Retrieved from the National Institute of Neurological Disorders and Stroke: ninds.nih.gov.
- NORD. (2015). Essential Tremor . Retrieved from the National Organization for Rare Disorders: rarediseases.org.
- Orphanet. (2011). Hereditary essential tremor . Retrieved from Orphanet: Orphanet.
- Velasco, B. (2007). Treatment of essential tremor. Med Clin (Barc), 129 (6), 222-7.
- What is Essential Tremor? (2016). Retrieved from Jhons Hopkins Medicine: hopkinsmedicine.org.