What is essential tremor and how is it treated, suffered by more than 60 million people in the world?

The essential tremor is a disorder of nervous system that affects humans. Generate involuntary movements and rhythmic. It usually occurs in the handsbut in some people it can also appear on the head, chin, or a combination.

The head of the Buenos Aires government, Horacio Rodriguez Larreta, he spoke again about his condition. “I was diagnosed when I was 5 years old. It is a condition that affects the pulse, although it never changed my life. However, he is there and he makes some situations live differently from the rest, ”he said. He had already made reference to the subject in 2016.

It is also known as postural or action tremor. “Essential tremor consists of a simultaneous contraction of antagonistic muscles but of different intensity and duration. It is symmetrical in both members, and appears when doing some activity. It does not appear when it is idle. Usually people with essential tremor have a family history of the disorder,” he told infobae the neurologist Hernán Pavón, from the Institute of Neurosciences of the German Hospital.

Essential tremor usually occurs when the person holds their arms outstretched in a fixed position and when picking up and moving an object, such as a glass of water. In general, the prevalence of this type of tremor for all ages is low. It is estimated that 1.13% of the population have it. It is more common at an older age.

“Because there is little knowledge, people or their loved ones are often scared when they perceive essential tremors. They believe that the person has Parkinson’s, which is a disorder that can produce another type of tremor”, explained Dr. Pavón.

For every 3 cases of essential tremor, there is approximately one case of Parkinson’s. In the case of Parkinson’s, the tremor of the arms is asymmetric.

Once a clinical diagnosis of essential tremor is made, there are several treatment options. “Pharmacological treatments do not cure essential tremor disorder, but they allow the intensity to be lowered and help patients maintain a good quality of life,” said the expert.

The intensity of the tremors can vary according to the emotional state of the patients, after doing physical activity, or due to the consumption of coffee or soft drinks, among other factors.

Many patients do not feel bothered by essential tremor and lead a normal life without consulting a health professional. “Some patients come to the consultation because the intensity of the tremors increased. Others come because their relatives are worried when they see the tremors,” said Dr. Pavón.

As treatment, beta-blockers, anxiolytics and muscle relaxants, anticonvulsants, among others, are indicated. These are drugs that are also used for other pathologies.

Surgery may be indicated in some patients who have not responded to medication. “There are different surgeries, such as one that is directed at a point in the brain. Another inserts an electrode and generates brain stimulation. There is a more recent method that is focused high-intensity ultrasound: it generates a lesion in an area of ​​the thalamus of the brain to compensate for the alteration by which the disorder occurs”, explained the specialist from the German Hospital.

Until recently it was said that the cause of essential tremors was unknown. “However, now there are studies that suggest that there are alterations in the cerebellum that cause involuntary movement in patients with essential tremors,” Pavón said.

“Usually the disorder does not cause complications. With medication, patients improve, although it does not disappear. In some cases, social stress causes the tremor to increase in intensity. Sometimes the patient feels the tremor more than what others perceive.

Ricardo Maiola, a neurologist and member of the Parkinson’s and involuntary movements program at the Hospital de Clínicas of the University of Buenos Aires, told infobae that “essential tremor is more common than tremor in Parkinson’s disease. It is generally well tolerated by patients. In some cases they may have balance problems, but it is not the most relevant thing”.

When treating a person with essential tremors, “you have to see if they have hyperthyroidism or if they are using asthma drugs. Because those situations may be generating the tremors. Once those conditions are ruled out and you have no signs of another disease, treatment for essential tremor is considered. In some cases they do not need treatment”, commented doctor Maiola.

In each case, the impact of tremors on people’s lives is evaluated. “Different groups of drugs are indicated. In some cases, they can lower the amplitude and intensity of the tremor. But they can have adverse effects. Therefore, a medical control is needed”, Maiola recommended. “In cases of surgery, patients have to know that it is a procedure with potential side effects and has certain risks,” she said.

According to a review published by the magazine Nature Reviews Disease PrimersEssential tremor is one of the most common movement disorders, with more than 60 million people affected worldwide.

Patients present primarily with motor features, such as postural and action tremors, but may also have other non-motor features. Genetics are responsible for most of the risk of essential tremor, but environmental factors may also play a role.

Some studies, according to the authors, have observed structural changes in cerebellar Purkinje cells and neighboring neuronal populations, and other studies have found GABAergic dysfunction and dysregulation of the cerebellar-thalamic-cortical circuitry.

The authors believe that further research is still needed to identify new pathophysiological clues and therapeutic targets and, together with advances in genomics and machine learning, could facilitate the development of precision medicine for patients with essential tremor.

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