5.  Treatment options for Essential Tremor

If tremor symptoms are mild and not concerning you, treatment might not be necessary. For those whose symptoms interfere with their quality of life, there are several treatment options available.

Lifestyle changes may reduce symptoms of tremor. For example, reducing or eliminating caffeine and other stimulants from your diet may help. Physiotherapy and rehabilitation may also assist patients with ET.

The three main options for the treatment and management of Essential Tremor are:

  1. Oral medications
  2. Deep brain stimulation
  3. Ablative neurosurgery

Oral medications

Most people with Essential Tremor benefit from drug therapy ?and early, appropriate treatment may delay or even eliminate functional disability. There are many types of oral medication available including propranolol, primidone, nadolol, topiramate, methazolamide and benzodiazepines. These may be prescribed separately or in a combination.

Your doctor will be able to discuss the individual benefits and side effects of the many drugs now available.

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Deep brain stimulation

Deep brain stimulation (DBS) uses an implantable medical device similar to a cardiac pacemaker, which treats the main symptoms of Essential Tremor by delivering electrical stimulation to a precisely targeted area deep within the brain. Fully reversible, this implant surgery helps control the main symptoms of Essential Tremor.

It is most suitable for patients whose symptoms are not well controlled by drug treatment, or who cannot tolerate the side-effects of their recommended medication.

The electrical signals delivered by DBS de-activate the target site within the brain without destroying any tissue. The goal is to restore the balance of electrical activity within the brain, by blocking the brain signals that cause the tremors.

The electrical signals are also adjustable, allowing more precise calibration and targeting of the effect. This can help improve your symptom control and reduce the risks of accidental damage to neighbouring areas.

The surgery is conducted under a local (rather than general) anaesthetic, because you need to provide feedback to help the neurosurgeon locate the exact target for the DBS. The use of a rigid metal frame, which holds your head perfectly still, helps ensure precise guidance of the instruments during surgery.

DBS requires repeat visits to the neurologist, so that the electrodes can be precisely programmed to deliver the maximum benefit.

Any surgery is a major procedure. The risks during and immediately after surgery include infection, haemorrhage, and even death. Complications from surgery may include cognitive impairment, swallowing difficulty, visual impairment, seizures, and headache. While many of these complications will improve over time, they can persist without improvement in some patients.

You, your caregivers, and your movement disorder specialist must work together to determine if surgery is the right option for you. Your neurologist and a neurosurgeon will then help you choose the right procedure. When all of these factors are considered carefully, surgery does have the potential to significantly improve your quality of life with ET.

There is also the chance that any part of the hardware ?the electrodes in the brain, battery-powered pulse generator in the chest, and wire connecting them under the skin ?may malfunction or break. The equipment would then require surgical removal or replacement.

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Ablative neurosurgery

Ablative surgery destroys a selected region of the brain. Thalamotomy, the lesioning or surgical destruction of specific cells of the brain's thalamus, is one kind of ablative surgery that has been used to control tremor.

Thalamotomy may be a suitable treatment for some patients. However, the lesioning is irreversible and non-adjustable, so the destroyed tissue cannot be replaced and the side effects cannot be adjusted. Ablating some sites also runs the risk of damaging brain cells that influence vision, swallowing, and verbal ability.

Again, any surgery is a major procedure. The risks during and immediately after surgery include infection, haemorrhage, and even death. Complications from surgery may include cognitive impairment, swallowing difficulty, visual impairment, seizures, and headache. While many of these complications will improve over time, they can persist without improvement in some patients.

You, your caregivers, and your movement disorder specialist must work together to determine if surgery is the right option for you. Your neurologist and a neurosurgeon will then help you choose the right procedure.

If you are suffering from a movement disorder, discuss treatment options with your doctor, and ask for a referral to a movement disorder specialist near you

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