Fact Or Fiction: Understanding Essential Tremors
Any person can have a tremor. Anxiety, excess caffeine, skipped meals, medications, alcohol, stress these are all things that can cause a slight shake of the hands. However, there are also a number of neurological disorders that can also cause a tremor according to neurosurgeon, Hooman Azmi, M.D.
Shaky hands may often be mistaken for Parkinsons disease however, one of the most common causes is essential tremors. Essential tremor is a neurological disorder that causes involuntary, rhythmic shaking. Its estimated that 10 million people in the U.S. suffer from an essential tremor, shares Dr. Azmi, who helps us separate the facts and fiction of essential tremor.
An essential tremor only presents as hand shaking: FICTION
While tremors most commonly affect the hands, they can also affect the head, voice, arms, tongue, legs or even trunk.
Head tremors can appear as the head shaking in a yes-yes, or no-no rhythm. Some may have a spasmodic dysphonia, a voice tremor, shares Dr. Azmi. If youve heard this once, its easy to recognize theres a shaking of the larynx and vocal chords affecting the voice. A persons voice may be shaking, and have a see-saw quality.
If you have a tremor, you have Parkinsons disease: FICTION
A tremor can be a symptom of Parkinsons disease, however, it does not mean that you have Parkinsons, explains Dr. Azmi. It could be an essential tremor.
The cause of essential tremors is unknown: FACT
Anxiety or caffeine can make tremors worse: FACT
Research On Caffeine And Et
Two studies shed some light on the effect of caffeine and essential tremors.
1. A 30-year old study compared tremor patients with a non-tremor control group. Based on questionnaires before taking a single oral dose of caffeine , eight percent of ET patients and six percent of PD patients thought that coffee worsened their tremor. These numbers compare to only two percent of the control group who thought that coffee made their hands shaky. Once the participants had consumed the dose of caffeine, they were followed at 1, 2 and 3 hours after ingestion. The study team found that caffeine only infrequently causes tremor in normal people, and it does not make either ET tremors or PD tremors worse.
2. A contemporary study likewise compared two groups, ET patients and matched non-tremor controls. In this questionnaire-based research, the intake of coffee and tea of all participants was recorded for analysis, and for correlating with each persons tremor score and the duration of their condition. The authors found no correlation between caffeine consumption and the severity or duration of ET. As they summed it up, Caffeine consumption was not associated with risk of ET in our study population.
The Truth Lies Somewhere Between
If these two studies, 30 years apart, suggest that theres no link between caffeine and the frequency or severity of ET, what does this say about the experience of individual patients whose tremors are aggravated by coffee or tea? In all likelihood, the truth may lie somewhere between the research and the patient world. Since fatigue is a recognized factor in making tremors worse, its possible that caffeine itself is not the tremor-causing culprit, but it may result in patients feeling more wakeful . Insufficient sleep can make a LOT of things worse!
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Can Surgery Treat Essential Tremor
Surgery should be considered for patients with disabling tremor that is not adequately controlled with drug therapy.
The proven surgical treatments are:
- Chronic thalamic deep brain stimulation .
- Stereotactic thalamotomy.
Patients who cannot undergo surgery include those who have medical conditions other than essential tremor that make them poor surgical candidates and those with a significant loss of thinking ability.
Surgical procedures allow patients to potentially reduce their tremor medicines.
Cause Of Essential Tremor
Essential tremor is the most common type of tremor, and affects more people than Parkinsons disease. Some estimates suggest that around 1 in 5 people over the age of 65 years is affected.
There is no known cause, but a genetic link is strongly suspected. Each child of a person with essential tremor has a 50% chance of inheriting the disorder themselves. If a person with essential tremor has other affected family members, then the disorder is called familial tremor.
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What Is Essential Tremor
Essential tremor is a neurological disorder that causes your hands, head, trunk, voice or legs to shake rhythmically. It is often confused with Parkinson’s disease.
Essential tremor is the most common trembling disorder. Everyone has at least a small degree of tremor, but the movements usually cannot be seen or felt because the tremor is so small. When tremors are noticeable, the condition is classified as essential tremor.
Essential tremor is most common among people older than 65, but it can affect people at any age. Some experts have proposed considering ET that starts earlier in life as essential tremor and ET that begins later in life as age-related tremor, because the conditions may have different symptoms and may respond differently to treatments.
Does Essential Tremor Affect Typing
Essential tremor is most noticeable when your body is in action, such as when you are writing, typing or pouring a beverage. In contrast, the tremors of Parkinsons are more noticeable at rest. In essential tremor, tremors begin when you use your hands. For example, when you are writing, typing or pouring a beverage.
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What Are The Types Of Tremor
There are several types of tremor, including:
- Essential tremor, sometimes called benign essential tremor. This is the most common type. It usually affects your hands, but it can also affect your head, voice, tongue, legs, and trunk.
- Parkinsonian tremor, which is a common symptom in people who have Parkinson’s disease. It is usually affects one or both hands when they are at rest, but it can affect the chin, lips, face, and legs.
- Dystonic tremor, which happens in people who have dystonia. Dystonia is a movement disorder in which you have involuntary muscle contractions. The contractions cause you to have twisting and repetitive movements. It can affect any muscle in the body.
Harmful Effects Of Chemical Solvents Used In Decaf Coffee
The most common method for decaffeinating the coffee beans uses chemical solvents that may leave a residue on the coffee seeds. Soaking the coffee seeds in several chemical solvents such as methylene chloride and ethyl acetate for about 10 hours may be the reason for this. The beans are steamed again to remove most of the solvents. Be known that the FDA allows residues of these solvents to remain on the decaf coffee beans even after roasting.
Its up to you to decide whether the trace elements of these chemicals should be inside your morning coffee or not. Consuming methylene chloride and ethyl acetate on a regular basis will vastly increase a persons chances of getting a serious disease such as cancer. The industrys marketers never mention this, and they know what happens when the knowledge is made public.
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What Should I Know About Living With Essential Tremor
Essential tremor is not life-threatening, but it can be very distressing for people who have it. The distress is more acute for people with severe symptoms. Simple activities such as eating, writing, or picking up a cup can be challenging and frustrating.As the disease progresses and tremors become more pronounced, many people feel anxious and embarrassed in social situations, making those situations worse. Eating a forkful of food without spilling, drinking a glass of water in a restaurant, speaking in a meeting without a trembling voice, or writing a legible check can become trying tasks.Some people with ET may feel tempted to withdraw from family and friends, but avoiding social situations is not recommended. There are practical tips, in addition to doctor-prescribed treatments, that allow people with ET to maintain active social lives. Staying socially active is an important part of maintaining emotional and physical well-being.
Medications For Essential Tremor
Propanolol and primidone are two of the medicines often prescribed to treat essential tremor.
Propanolol blocks the stimulating action of neurotransmitters to calm your trembling. This beta blocker is effective in 40% to 50% of patients and is less useful in reducing head and voice tremor. It is usually avoided in patients with asthma, emphysema, congestive heart failure or heart block, and should be used with caution by people with diabetes who are on insulin. These drugs may reduce exercise tolerance, lower blood pressure or heart rate, exacerbate depression and cause impotence. Other adrenergic blockers with fewer side effects include atenolol, nadolol, metoprolol and timolol.
Primidone controls the actions of neurotransmitters. Some patients starting primidone may experience a first dose phenomenon during which they have transient feelings of unsteadiness, dizziness and nausea during the beginning stages of treatment. This is usually short-lived. Sedation is another common side effect and can be reduced by following a slowly escalating dose schedule. Most patients are able to tolerate the side effects, and studies have shown that 60% to 100% of patients respond positively.
If primidone or propranolol are not effective by themselves, a combination of both may provide relief for some patients.
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Treatment Of Essential Tremor
There is no cure for essential tremor. Treatment aims to suppress the involuntary movements. To identify the best treatment, you should consult with a Neurologist. Treatments can include:
- avoidance of known triggers, such as alcohol or caffeine
- some medications used to treat other medical conditions, such as heart disease and epilepsy these medications have been helpful in some cases
- other medications, including tranquillisers
- deep brain stimulation, a surgically implanted device that helps to short-circuit the impulses or brain waves causing the tremor
- brain surgery to alter the part of the brain causing the tremor has been successful in some cases
- MRI guided focused ultrasound
- regular monitoring and observation if the tremor is mild and doesnt stop the person from performing their usual activities, this may be the only treatment.
In some cases, alcohol may reduce the tremors. However, this is not a recommended treatment, because long-term consumption of alcohol has significant health risks.
What Are The Symptoms
Symptoms of essential tremor vary from person to person, as does the rate of progression.
- Rhythmic tremors of the hands, legs, or trunk
- Head nodding in a “no-no” or “yes-yes” motion
- Voice quivering
- Tremors that occur involuntarily and cannot be stopped.
- Tremors that get worse during periods of stress and that lessen during rest.
- In rare cases, mild gait disturbance.
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Caffeine And Essential Tremor
Caffeine is a stimulant that interacts with the nervous system, and is the world’s most consumed psychoactive drugs. Caffeine has a number of defining characteristics, but the most prominent is that it blocks adenosine which prevents drowsiness that is induced by adenosine. Caffeine also, at the same time stimulates certain portions of the autonomic nervous system. Caffeine is a white, crystal like substance that can be found naturally in seeds, nuts and types of plants in Africa and south America. It helps protect the plants against predator insects. The most well-known natural source of caffeine is through Americas favorite drink, coffee and the coffee bean. Most people consume coffee today through coffee, tea, and sodas. 85 percent of adults consume coffee in America every day, and consume around 164 mg on average.
Normally caffeine can have positive and negative health effects. It can treat and prevent premature infant breathing disorders, and it may have some protective effect against some diseases like Parkinson’s disease. We all know that when we drink caffeine we may not be able to sleep as well, and that we can be somewhat addicted to it and experience withdrawals and tolerances to it. But how does it affect essential tremor?
Is The Essential Tremor Usually In One Hand
Dr. Miller: Is essential tremor mostly in both hands, or is it usually in one? Dr. Schrock: In most people, essential tremor will come on in both hands. Most patients who come in will complain of it more in their dominant hand, of course, but when you actually examine them theyll have the tremor in both hands.
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Alcohol Abuse Or Withdrawal
You might also experience a racing heart, weight loss, insatiable hunger, perspiration, exhaustion, effects of alcohol and heat intolerance. Caffeine cansometimes induce tremorif you drinktoo much of it.
Quick recognition of alcohol withdrawal SHOT: sweating, hallucinations, orientation, tremor. If > = 2 then treat with Benzos. Much easier than CIWA. This is for management in the office but can be a quick screen in the ED. #etohwithdraw#shot#quicktips
The beta-blocker propranolol has been used to treat essential tremor for more than 40 years. Other beta-blockers such as metoprolol also may be effective.
How About Its Effects On The Severity Of Tremor
Researchers have also studied the effects of caffeine intake on the severity of tremor in patients. In the majority of cases, no such relation was found. Here, we have an example of two studies.
The first is a questionnaire-type study that compared the current daily intake of caffeine among participants and linked it with the severity of tremor. The study, which was published in the Journal of Movement Disorder, included a total of 130 ET patients and 175 controls subjects.
The study found that daily caffeine intake was not correlated with tremor severity or duration. It was found that ET patients consumed less caffeine than did controls and the study suggested that it could be due to a dietary modification in response to tremor.
The second study is a rather old one and it was published in the journal of Neurology. This was also a questionnaire-based study that collected data on the effect of a single oral dose of caffeine in tremor patients and compared it with data from control non-tremor individuals. The participants were observed for the presence of tremor after 1, 2, and 3 hours of caffeine intake. The study found that only 2% of the control group observed caffeine made their hands shaky. 8% of ET and 6% of Parkinsons patients noted that that coffee worsened their tremor. The study concluded that caffeine only infrequently induces tremor in normal people, and it does not exacerbate pathologic tremor.
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What To Expect From Your Doctor
The organization encourages and promotes research in an effort to determine the causes, treatment, and ultimately the cure for ET. Ask your doctor about briefly discontinuing certain prescriptions right before you attend social events. Some medications, like thyroid or asthma treatments, may aggravate tremors. Our experienced team is committed to transforming alcohol addiction treatment. Currently, there is no evidence that alternative treatments are beneficial in treating Essential Tremor. Patients who have tremors that worsen with emotional stress may find relaxation therapies helpful at temporarily easing symptoms. The risk of developing essential tremor increases with age, but anyone can have it, including children.
There are many reasons people struggle to give up excessive drinking, but the symptoms of alcohol withdrawal are among the most intimidating. If you often experience shakiness after drinking alcohol, there are several solutions. One good first step is to check in with yourself about your alcohol consumption. If you notice yourself drinking often, tremors from alcohol might be a sign that its time to cut back.
The Best Diet For Essential Tremor
May 24, 2018
Because the causes of Essential Tremor are somewhat mysterious, figuring out the best diet for Essential Tremor can be quite the task. Though ET is not controllable, it is different from Parkinsons and other diseases because it isnt progressive like those Tremor problems. According to the NIH, deep brain stimulation can be used to help eliminate tremor triggers. Aside from DBS, there are dietary restrictions and rules that can help control tremors.
The best diet for essential tremor does not include caffeine and other stimulants. These elements can cause tremors to become worse for a period of time, and can overstimulate the muscles so tremors are overactive. Consuming very little alcohol will also help control ET. All of these things could cause the brain and muscles to be stimulated in ways that cause tremors.
In a diet study performed by Nikolaos Scarmeas and Elan D. Louis they compared ET sufferers who ate closer to a Mediterranean based diet and those who did not. After taking away gender, race and other factors, they found that higher adherence to the diet was in correlation with significantly lower odds of Essential Tremor.
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Causes Of Essential Tremor
The exact cause of essential tremor is unknown, but essential tremors tend to occur when there are nerve-related problems that influence the muscles with which they are connected. Research has also indicated that the part of the brain that controls the movement of muscles may not function properly in patients with essential tremor. In some cases, several family members may have essential tremor, known as familiar tremor and it is believed to be caused by a genetic mutation.
How Does Essential Tremor Develop
Essential tremor symptoms often first appear in a person’s 40s, when delicate movements such as threading a needle become difficult. But it’s usually not until people reach their 50s or 60s that the tremor becomes troublesome for example, making it difficult to use a fork, drink from a cup, or write a letter. Essential tremor progresses slowly. Though essential tremor may eventually affect the voice and head, many people find that their symptoms don’t progress beyond mild hand and arm tremor. Tremors are usually absent during sleep.
We don’t know the precise cause of essential tremor. Some experts believe that the problem lies in the cerebellum or its connections with the brainstem, which lies at the base of the brain. Essential tremor is a heritable condition. If you have essential tremor, your children will have a 50% chance of developing it as well.
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