There is no cure for most tremors. The appropriate treatment depends on accurate diagnosis of the cause.
Some tremors respond to treatment of the underlying condition. For example, in some cases of psychogenic tremor, treating the patient's underlying psychological problem may cause the tremor to disappear.
Symptomatic drug therapy is available for several forms of tremor. Drug treatment for Parkinsonian tremor involves levodopa and/or dopamine-like drugs such as pergolide mesylate, bromocriptine mesylate, and ropinirole. Other drugs used to lessen Parkinsonian tremor include amantadine hydrochloride and anticholinergic drugs.
Essential tremor may be treated with propranolol or other beta-blockers (such as nadolol) and primidone, an anticonvulsant drug.
Cerebellar tremor typically does not respond to medical treatment. Patients with rubral tremor may receive some relief using levodopa or anticholinergic drugs.
Dystonic tremor may respond to clonazepam, anticholinergic drugs, and intramuscular injections of botulinum toxin. Botulinum toxin is also prescribed to treat voice and head tremors and several movement disorders.
Clonazepam and primidone may be prescribed for primary orthostatic tremor.
Enhanced physiologic tremor is usually reversible once the cause is corrected. If symptomatic treatment is needed, beta-blockers can be used.
Eliminating tremor "triggers" such as caffeine and other stimulants from the diet is often recommended.
Physical therapy may help to reduce tremor and improve coordination and muscle control for some patients. A physical therapist will evaluate the patient for tremor positioning, muscle control, muscle strength, and functional skills. Teaching the patient to brace the affected limb during the tremor or to hold an affected arm close to the body is sometimes useful in gaining motion control. Coordination and balancing exercises may help some patients. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.
Surgical intervention such as thalamotomy and deep brain stimulation may ease certain tremors. These surgeries are usually performed only when the tremor is severe and does not respond to drugs.
Thalamotomy, involving the creation of lesions in the brain region called the thalamus, is quite effective in treating patients with essential, cerebellar, or Parkinsonian tremor. This in-hospital procedure is performed under local anesthesia, with the patient awake. After the patient's head is secured in a metal frame, the surgeon maps the patient's brain to locate the thalamus. A small hole is drilled through the skull and a temperature-controlled electrode is inserted into the thalamus. A low-frequency current is passed through the electrode to activate the tremor and to confirm proper placement. Once the site has been confirmed, the electrode is heated to create a temporary lesion. Testing is done to examine speech, language, coordination, and tremor activation, if any. If no problems occur, the probe is again heated to create a 3-mm permanent lesion. The probe, when cooled to body temperature, is withdrawn and the skull hole is covered. The lesion causes the tremor to permanently disappear without disrupting sensory or motor control.
Deep brain stimulation uses implantable electrodes to send high-frequency electrical signals to the thalamus. The electrodes are implanted as described above. The patient uses a hand-held magnet to turn on and turn off a pulse generator that is surgically implanted under the skin. The electrical stimulation temporarily disables the tremor and can be "reversed," if necessary, by turning off the implanted electrode. Batteries in the generator last about five years and can be replaced surgically. DBS is currently used to treat Parkinsonian tremor and essential tremor.
The most common side effects of tremor surgery include dysarthria (problems with motor control of speech), temporary or permanent cognitive impairment (including visual and learning difficulties), and problems with balance.
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