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Is your tremor a sign of Parkinson's disease?

More likely, it's essential tremor or something else. Seek help to find the cause and put a stop to your shakiness.

Your hands axe shaky. Over the years they've twitched every now and then whenever you wrote a note or used a tool or utensil. Now that you're older, those hand tremors are occurring a little more frequently, and you're concerned you might have something worrisome, like Parkinson's disease (PD).

Statistically speaking, you're more likely to be exhibiting signs of the most common type of movement disorder, benign familial essential tremor (ET), which is at least eight times more common than PD, according to the International Essential Tremor Foundation (IETF). Whatever the cause, if your tremors begin to affect your quality of life, it's time to find answers.

"When should you be concerned about tremors?" asks neurologist Tarannum Khan, MD, a Cleveland Clinic Florida movement disorders specialist. "With one episode of tremor, you should not be concerned at all. But, if it's more persistent and progressive over time, you should see a doctor."

Identifying Essential Tremor

ET often progresses slowly, and while for many patients it remains mild, for others it is life-altering.

Several factors can help you and your doctor determine if your shakiness is from ET or if it's a parkinsonian tremor. For instance, if you have a family history of tremor, you're more likely to have ET:


Typically occurs during an          Tremors occur more often at rest;
action, such as bringing a cup or   most often affect the hands, but
utensil toward your mouth.          the legs also can be affected.

Usually affects both arms or both   Most often affects one side of
sides of your body nearly           your body more than the other;
equally.                            eventually may progress to both

Most often causes shaky arms,       Tremors almost never affect the
hands or head or a trembling        voice and head; PD manifests in
voice; almost never affects the     the head more as an opening and
legs; manifests in the head as      closing of the mouth, diminished
side-to-side ("no-no") shaking      facial expression ("masked" face)
movements or head bobbing.          and a drop in voice level

Does not cause other health         Often characterized by decreased
disorders, such as immobility or    dexterity on one side of the
speech or memory problems.          body, handwriting changes,
                                    stiffness and rigidity in the
                                    arms/legs, stooped posture,
                                    balance problems, short stride
                                    length, or shuffling gait.

Symptoms may improve with           May produce immobility, speech
consumption of alcohol.             problems, and memory loss.

Family history of essential         Family history of Parkinson's
tremor present in the majority of   disease present in fewer than 10
patients.                           percent of patients.

Most commonly occurs in middle      Generally develops between ages
age, but can develop at any time    55 and 65.
of life.

Source: International Essential Tremor Foundation

More than half of patients with ET have a family history of the disorder, compared with less than 10 percent of those with parkinsonian tremors, according to the IETF.

Additionally, ET usually affects both sides of the body and occurs when you try to hold a body posture against gravity, reach toward something, or lift something toward you, Conversely, PD usually begins on one side of the body before progressing to the other side, and it occurs more often at rest. (See chart for other signs of ET versus PD.)

"Also, for Parkinson's disease, there are many, many other symptoms that accompany the tremor that are red flags that a person should definitely see a doctor," Dr. Khan says.

Finding the Cause

In some cases, your shakiness may not be a sign of ET or PD, but rather a different type of tremor or an underlying factor that your doctor must rule out, such as:

* Physiologic tremors, occurring in all healthy people and characterized by fine shaking of the hands and fingers.

* Other medical conditions, such as chronic liver or kidney disease, multiple sclerosis, low blood sugar, overactive thyroid (hyperthyroidism), traumatic brain injury, alcohol withdrawal, or severe anxiety.

* Use of medications/substances that cause tremors as a side effect. Some examples include divalproex (Depakote[R], used to treat seizures and bipolar disorder), certain antidepressants, asthma medications, immunosuppressants (e.g., cyclosporin and tacrolimus), caffeine, and nicotine.

No biomarker tests have been developed to definitively diagnose ET or PD, so Dr. Khan and other movement disorders specialists must rely more on their clinical expertise to pinpoint the cause of tremors.

"If someone has persistent tremors, it's best to see a neurologist, preferably one who is a movement disorders specialist," she advises. "A good examination by a movement disorders specialist usually is able to get the diagnosis."

Treating ET

If ET is affecting your quality of life, blood pressure medications known as beta blockers--usually propranolol (Inderal[R])--or the anti-seizure medication primidone (Mysoline[R]) may be prescribed. The wrinkle fighter botulinum toxin (Botox[R]) also may help. "If it's bothersome, it's a very good idea to get on a medication. We have very good medications for essential tremor and parkinsonian tremor," Dr. Khan says. "But, if it's mild, it's best left alone."

Also, in 2016, the U.S. Food and Drug Administration approved the first ultrasound device to treat ET. In this treatment, doctors use magnetic resonance imaging to target high-intensity focused ultrasound waves that destroy a tiny area of the brain believed to be responsible for ET.

If these non-invasive treatments fail, a surgical procedure known as deep-brain stimulation can provide dramatic relief for people with severe ET. A pacemaker-like device placed in the chest delivers electrical stimulation via electrodes placed in the brain to reduce tremors.

Like PD, ET is not curable, but its symptoms are manageable, Dr. Khan says. Simple lifestyle changes, such as limiting or avoiding caffeine, getting seven to eight hours of sleep each night, and finding ways to relax may help ease your symptoms. Also, take advantage of special utensils and assistive devices that can help you function better. Visit www. for more details.

"Benign essential tremor is more of a nuisance than it is a disease, as opposed to Parkinson's disease," Dr. Khan says. "The biggest issue with essential tremor is to manage life."
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Title Annotation:NEUROLOGY
Publication:Men's Health Advisor
Date:Sep 1, 2017
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