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Essential Tremor

Shaking or trembling of the hands is a common condition that can occur to anyone, especially when you are excited, stressed, and anxious or after drinking caffeine. However, if the tremor becomes worse, it can signal that you are experiencing “Essential Tremor”. Although Essential tremor is not life-threating, it can be embarrassing and when left untreated, the symptom may interfere with normal activities or working life in the future.

 
Essential Tremor
 
1.Genetics, known to be hereditary in an autosomal dominant manner.
2.Environment, certain foods may cause tremor.
 
 
Which “Shaking” is considered as Essential Tremor?
Shaking or trembling body part can be a sign of many conditions such as Parkinson’s which the tremor usually develops on one side of the body. Essential tremor, on the other hand, appears on both side of the body and the tremor become clear when trying to do activities with your hand such as when holding the spoon, or writing. The head and voice can also be affected in some people who have had tremor for a long time.
 
If you notice that your hand starts shaking and the tremor is caused by stress, anxiety, or physical exercise, this can be a normal condition. Some people with essential tremor does not require the treatment if the tremor does not make it harder for them to work or perform daily life tasks, they can still drink from a cup or glass without spillage, or eat without spilling. However, if shaking is present when the hands are at rest, happens routinely, gets worse and affects daily activities and personality; you should visit the doctor for testing and diagnosis. The medical treatment can help control the symptoms.
 
 
Treatment
1.Medications 
Propanalol is often used to treat essential tremor (ET), a low initial dose is advised and if there is no side effect, doctor will increase the dose.  This drug should be used with caution in patients with heart disease or lung disease, and the doctor may switch to Topiramate or Gabapentin in the event of medication side effects.
 
2.Focus Ultrasound Therapy
It is a non-invasive treatment guided by MRI to locate the area of the brain-Thalamus that causes the tremor. Radiofrequency or other form of energy will then be used to precisely destroy the tremor source without harming adjacent tissue. The advantage is this treatment is not the brain surgery which is a major and highly invasive procedure.
 
3.Deep Brain Stimulation is the surgical procedure to place a thin metal electrode in the thalamus of the brain; the electrode is connected to a type of pacemaker device, which is implanted under the skin in the chest. When pacemaker is turned on, the device sends signal to activate the electrode and alters the abnormal function of the brain tissue in the area of the stimulating electrode.
 
Shaky hands can results from several problems including Parkinson’s, Essential Tremor, or some kinds of medicines, if you notice your hands shaking uncontrollably and routinely, seek an advice from medical professional.
 
 
Dr.Karn Sakdisornchai
Neurologist
Neurological Center, Phyathai 2 Hospital


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