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Treating essential tremor

Treating Essential Tremor

The objective of treatment for essential tremor is to reduce or remove the involuntary movements as much as possible.

If your tremor is mild and doesn't stop you from carrying out normal activities, your condition should simply be monitored. Try to avoid things that may make your tremor worse, such as:

  • Caffeine: Caffeine is found in coffee (reduced amount in decaffeinated coffee), tea, cocoa, soft drinks (especially those containing cola), alcoholic energy drinks, and some brands of root beer and energy drinks. It may also be found in chocolate bars, coffee and chocolate flavoured ice-cream, energy bars, certain brands of instant breakfast oatmeal and meat jerky, and some over-the-counter medications, such as cough syrup, pain relievers, breathe fresheners, and slimming tablets. 

  • not getting enough sleep

  • stress

  • Extreme temperatures

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Taking certain medications – including some antidepressants, lithium and treatments for asthma can cause tremor.  Speak to your GP if you're taking medicine which could be causing a tremor. You should only stop taking prescribed medication if your doctor specifically advises you to.

 

However, before discussing medication and surgical intervention I would like to start with a review of natural therapies and remedies, which include therapy and stress management, essential oils, herbal remedies and physical exercise.  All of these have a track record in helping to alleviate or eliminate tremors.

Stress management

Anxiety and stress are common causes for exacerbation of essential tremor.  It is important to remember that anxiety and stress are common and can be effectively treated. Don’t be afraid to say if you feel stressed or anxious – this is key to getting help and overcoming such emotions.

 

All involuntary movements, including tremor, are worsened by emotional or physical stress, anxiety, fatigue and coincidental illness. Uncontrolled stress can make tremor very difficult to manage, and it can make Essential Tremor uncontrollable. Stimulants such as caffeine, coffee, chocolates, recreational drugs, and alcohol withdrawal will worsen tremors. For these reasons a wholistic approach to dealing with tremor can be just as effective as being prescribed additional medication. 

 

Heartmath meditation and biofeedback has a track record for being very successful in reducing the severity of essential tremor.  You can read a patient’s testimony below.

 

Other complementary therapies to promote relaxation and reduction of stress, can be very valuable as well. Psychological inputs, including cognitive behavioural therapy, relaxation therapies, meditation, neuro-behavioural training and neuro-linguistic programming all have parts to play in the management of some individuals. Likewise, nutritional changes may be essential. However, for any of these solutions to work, you must reduce stress, including the stress the tremors themselves cause.

Natural remedies

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Essential oils

Sacred Frankincense essential oil - is used to relieve nervous tension and depressions. It is also known as an anti-infective respiratory tract that stimulates the immune system. Frankincense oil has psycho-emotional properties that can curb essential tremors. Once taken, this essential oil acts as a nervous system stimulant and Calms nervous tension.

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Vetiver oil - Like the frankincense oil, it acts as a stimulant which ends up calming the nervous system.

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Arnica oil - This powerful oil relieves certain conditions in tremor sufferers. Combined with marjoram and rosemary essential oils, in increases the ability for arnica oil to reduce inflammation and muscle spasms. Lemon and orange essential oils both work with the central nervous system to boost mobility. When consumed, arnica has positive effects on the nervous system. Treatment is usually given as an infusion by diluting in water. Arnica can be consumed by mixing three granules in 500 ml of water in a bottle. Before consumption, the bottle must be shaken, and the mixture sipped. A teaspoon of the mixture is consumed three times a day for quick relief.

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Helichrysum Oil - Inflammation relieving properties have been discovered in Helichrysum essential oil. These properties place Helichrysum at the top of the list as one of the best essential oils for treating essential tremors. The theory denotes that lowering the level of brain inflammation in an individual suffering from the condition may lead to some relief from the symptoms.

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Cinnamon oil - There are several health benefits that come along with cinnamon essential oil. Recently it has been at the centre of attention in relation to diabetes.  However, researchers speculate that it may also be one of the best essential oils for tremor due to its properties

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Herbal remedies

First a word of warning: I strongly recommend that prior to using any herbal remedies you seek the advice of an herbalist, naturopath or a nutritionist.

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Skullcap - Skullcap is used as a mild relaxant. It’s an anti-anxiety herb as well as a natural remedy to help relieve convulsions, such as those associated with essential tremors. Due to the excellent calming properties associated with this herb, it is highly beneficial for essential tremor sufferers.

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Passionflower - This herb is mainly used for its relaxing properties. It is believed to increase the gamma-aminobutyric acid level, or GABA within the brain. When brain GABA levels are reduced, the brain cell activity is calmed-down resulting to a relaxed state. Thus, reducing the severity of essential tremor.

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Valerian - Valerian has been used to treat anxiety, nervous restlessness, and insomnia for centuries. Valerian is among the best known herbal remedies for promoting relaxation, which is a corner stone in treating essential tremor. 

Exercise

Hand tremors can be a nuisance and make performing daily tasks quite difficult. Occupational therapy or hand exercises can help your hands become steadier. Curing hand tremors largely depends on the underlying cause of your condition.  Before beginning exercises for hand tremors, your condition should be diagnosed by your doctor. Treatment for an underlying condition may help lessen or completely stop your hand tremors. Your doctor may also prescribe occupational or physical therapy to help you cope with your hand tremors. 

Prior to beginning exercises to strengthen your wrists and alleviate tremors, loosen your wrists up. Perform wrist circles for 1.5 minutes in each direction.

 

Use a small rubber ball or stress ball to strengthen the hand affected by tremors. Place the ball in the palm of your hand and squeeze your fingers around it as tightly as possible. Hold this position for five seconds. Relax and repeat 12 times.

You may also strengthen your hand and wrist by using a lightweight dumbbell. Use a dumbbell that's 0.5kg to 1.5kg in weight. Position your hand and wrist -- palm side up -- over the edge of a table or rest it on your thighs so the hand hangs over the knee. Place the weight in your hand. Slowly move your wrist up and down. Complete one set of 20 repetitions.

In addition to hand exercise, you should participate in regular physical activity. Regular exercise can help lower stress levels, decrease your risk of disease and improve your overall health. 30 minutes of physical activity per day, five days per week is recommended.

Furthermore, you should perform body-weight exercises. Preform planks and push-ups to help strengthen your hands and wrists. Complete one set of 10 repetitions.

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Rest

Lack of rest and sleep leads to tiredness which can be a major cause for worsening tremor condition. There are methods to induce sleep and relaxation which are recommended over sleeping medication.

Medication

If your tremor is more severe, your doctor may prescribe medication to reduce your symptoms. The most popular and some say effective medicines are propranolol and primidone. Between 50% and d75% of people find these medicines to have a positive effect in decreasing their tremor.

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Beta-Blockers

Propranolol is a beta-blocker usually used to treat cardiovascular disease and high blood pressure (hypertension). It reduces tremors for a few hours after each dose. The possible side effects of taking propranolol include:

  • feeling sick

  • dizziness

  • cold extremities

  • impotence 

  • worsening of pre-existing asthma or heart failure

 

Anticonvulsants
Primidone is an anticonvulsant, which is common in treating epilepsy, which also seems to help reduce essential tremor. Possible side effects include low blood pressure, drowsiness and feeling sick.

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​Topiramate, may also occasionally be used. If these medicines don't work on their own, a ‘cocktail’ of propranolol and an anticonvulsant may be recommended.

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Gabapentin is an anticonvulsant. It has a modest benefit in ET and is often tried when propranolol and primidone are not effective. Gabapentin is generally well tolerated. Side effects include fatigue, slurred speech, drowsiness, impaired balance, and nausea, especially when beginning treatment. The drug has a short duration of action and requires multiple doses a day. In older persons, gabapentin is typically started at 100 mg three times daily; in younger persons it is often started at 300 mg three times daily.

 

Sedatives

If combining the above medicines doesn't work, there's some evidence that sedatives such as clonazepam and alprazolam can help. These may improve your tremor because they reduce anxiety, which can often make the tremor worse. However, sedatives can cause drowsiness and they have the risk of causing dependency.

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Antidepressants

Mirtazapine is an antidepressant. Due to its lack of effectiveness for the majority of persons with ET and its significant side effects, mirtazapine is not recommended for the routine treatment of ET. Adverse effects include confusion, dry mouth, weight gain, frequent urination, balance and gait difficulty, nausea, and blurred vision.

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Botulinum toxin

In rare cases, if the medicines described above prove to be ineffective, botulinum toxin may be used to treat essential tremor. The botulinum toxin (Botox) is injected directly into the quivering muscles to block nerve transmissions and relax the muscles.

Botulinum toxin type A is a powerful poison that's clinically safe when used in tiny doses. It's sometimes used to treat dystonic tremor rather than essential tremor. Dystonic tremor is a different type of tremor which causes involuntary muscle spasms and contractions (tightening).

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Intermittent treatment

Some people with essential tremor only wish to have medicinal treatment for specific times. For example, prior to going to a social engagement or before a particularly important meeting. In these situations a single dose of propranolol may ease the tremor satisfactorily for the occasion.

 

Surgery for severe tremor

Sometimes essential tremor may be so severe it considerably restricts normal activity and doesn't respond to medication. In these rare cases, surgery may be considered. There are two types of surgery:

 

 

These procedures are described below.

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Deep brain stimulation

Deep brain stimulation involves placing one or more electrodes (small metallic needles) in an area of your brain called the thalamus. This is done under general anaesthetic, though you are woken up during the procedure to make sure the electrodes are in the correct place.

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Thin wires run from the electrodes to a pulse generator (a device similar to a pacemaker), which is implanted under the skin of your chest. The generator produces an electric current to help regulate your brainwaves and control the tremor.

The National Institute for Health and Care Excellence (NICE) published guidelines on deep brain stimulation for tremor in 2006. NICE concluded the treatment is effective in improving tremor, but more information is needed about how successful it is in the long-term. Other research has found deep brain stimulation can reduce tremor by around 90%.

Possible adverse effects of deep brain stimulation include:

  • infection of the surgical scar site

  • speech impediments

  • tingling sensation

  • bleeding in the brain

  • fluid in the brain

  • stroke, a serious medical condition caused by the blood supply to part of the brain being cut off

  • complications of general anaesthetic, such as nerve damage and numbness

 

Discuss these risks with your surgeon before deciding whether or not to have the procedure.

In the research NICE looked at, side effects were relatively rare. More recent research has also concluded that deep brain stimulation is a relatively safe procedure. Certain side effects can be eliminated by adjusting the level of stimulation that are produced by the pulse generator.

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Thalamotomy

A thalamotomy involves making a small hole in the thalamus, which is the same area of the brain targeted in deep brain stimulation. The procedure has been shown to be effective in reducing tremor.

Deep brain stimulation is often preferred to thalamotomy because it usually causes fewer side effects and some side effects can be reversed by adjusting the stimulation parameters or abandoning stimulation altogether.

However, thalamotomy has some advantages over deep brain stimulation, such as avoiding the necessity for follow up appointments to check the pulse generator and battery replacement.

Side effects of a thalamotomy can include:

  • confusion and problems in coherent thinking

  • speech impediments and balance problems

  • bleeding in the brain

  • infection

  • paralysis

Tips for day-to-day living

Beyond medications and surgery, essential tremor patients also should choose tasks they plan to do thoughtfully, as well as the timing for these tasks. It is recommended that you:

  • Save tougher tasks for your best time of day - If the tremors seem better or worse at certain times of the day, or on certain days, plan to do handwriting tasks like paying bills or filling out greeting cards at those times when you feel better.

  • Consider a travel mug or straw for drinking - If you have trouble holding a coffee cup still, use a travel cup all the time. Straws also can make drinking easier.

  • Buy heavier, larger utensils - Using heavier eating utensils can sometimes “dampen out” tremors. You also may want to eat with utensils that have a larger handle to make control easier.

  •  Wear clothes that make it easy to dress - Buy clothes with Velcro fasteners or button hooks that make putting them on and off less challenging.

  • Find shoes that are easy to wear - Consider wearing slip-on shoes or using shoehorns.

 

Getting help

If you're affected by essential tremor, you can get in touch with the National Tremor Foundation (NTF) for help and support. You can also visit the NTF website for further information and advice.  In addition, a wealth of information can be found on the IETF website.

 

Patient’s testimony

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“I have had tremors for all of my 61 years.  When I was in music school, I couldn't even play in a lesson.
Then, when I was venting my frustration to my GP he said:  why don't you try Heartmath?
This is a cardiac breathing biofeedback program, which I do every day for five minutes.  It is a recommended follow-up to Neurofeedback.  After a while, you can "zone in" on your breathing at will and I can notice a significant reduction in my tremor”

 

Conclusion

Although science based evidence that supports nutritional solutions for essential tremor is scant at best, my own experience with tremor patients who followed my professional support has been quite successful in the majority of cases where clients followed a sustainable programme which included stress management, physical exercise and most importantly a customised diet.

If you have any questions or require my support please don’t hesitate to contact me

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