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Treatment of Essential Tremor

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Essential Tremor in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

Abstract

In this chapter, we discuss the treatment of essential tremor. Pharmacologically, in addition to propranolol and primidone, there are other medications that can be helpful. There have also been recent advances in non-pharmacologic options. Finally, deep brain stimulation and thalamotomy can be very effective surgical treatments for the appropriate candidates.

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References

  1. Louis ED. Essential tremor. Handb Clin Neurol. 2011;100:433–48.

    Article  PubMed  Google Scholar 

  2. Koller WC, Busenbark K, Miner K. The relationship of essential tremor to other movement disorders: report on 678 patients. Essential Tremor Study Group. Ann Neurol. 1994;35:717–23.

    Article  CAS  PubMed  Google Scholar 

  3. Lou JS, Jankovic J. Essential tremor: clinical correlates in 350 patients. Neurology. 1991;41:234–8.

    Article  CAS  PubMed  Google Scholar 

  4. Bain PG, Findley LJ, Thompson PD, et al. A study of hereditary essential tremor. Brain. 1994;117(Pt 4):805–24.

    Article  PubMed  Google Scholar 

  5. O’Connor RJ, Kini MU. Non-pharmacological and non-surgical interventions for tremor: a systematic review. Parkinsonism Relat Disord. 2011;17:509–15.

    Article  PubMed  Google Scholar 

  6. Rocon E, Belda-Lois JM, Ruiz AF, Manto M, Moreno JC, Pons JL. Design and validation of a rehabilitation robotic exoskeleton for tremor assessment and suppression. IEEE Trans Neural Syst Rehabil Eng. 2007;15:367–78.

    Article  CAS  PubMed  Google Scholar 

  7. Rocon E, Manto M, Pons J, Camut S, Belda JM. Mechanical suppression of essential tremor. Cerebellum. 2007;6:73–8.

    Article  PubMed  Google Scholar 

  8. Pathak A, Redmond JA, Allen M, Chou KL. A noninvasive handheld assistive device to accommodate essential tremor: a pilot study. Mov Disord. 2014;29:838–42.

    Article  PubMed  Google Scholar 

  9. Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011;10:148–61.

    Article  PubMed  Google Scholar 

  10. Zesiewicz TA, Elble R, Louis ED, et al. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2005;64:2008–20.

    Article  CAS  PubMed  Google Scholar 

  11. Zappia M, Albanese A, Bruno E, et al. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian Movement Disorders Association. J Neurol. 2013;260:714–40.

    Article  PubMed  Google Scholar 

  12. Diaz NL, Louis ED. Survey of medication usage patterns among essential tremor patients: movement disorder specialists vs. general neurologists. Parkinsonism Relat Disord. 2010;16:604–7.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Winkler GF, Young RR. The control of essential tremor by propranolol. Trans Am Neurol Assoc. 1971;96:66–8.

    CAS  PubMed  Google Scholar 

  14. Larsen TA, Teravainen H. Beta 1 versus nonselective blockade in therapy of essential tremor. Adv Neurol. 1983;37:247–51.

    CAS  PubMed  Google Scholar 

  15. Leigh PN, Jefferson D, Twomey A, Marsden CD. Beta-adrenoreceptor mechanisms in essential tremor; a double-blind placebo controlled trial of metoprolol, sotalol and atenolol. J Neurol Neurosurg Psychiatry. 1983;46:710–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Cleeves L, Findley LJ. Propranolol and propranolol-LA in essential tremor: a double blind comparative study. J Neurol Neurosurg Psychiatry. 1988;51:379–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Koller WC. Long-acting propranolol in essential tremor. Neurology. 1985;35:108–10.

    Article  CAS  PubMed  Google Scholar 

  18. Koller WC, Royse VL. Efficacy of primidone in essential tremor. Neurology. 1986;36:121–4.

    Article  CAS  PubMed  Google Scholar 

  19. Connor GS, Edwards K, Tarsy D. Topiramate in essential tremor: findings from double-blind, placebo-controlled, crossover trials. Clin Neuropharmacol. 2008;31:97–103.

    Article  CAS  PubMed  Google Scholar 

  20. Gironell A, Kulisevsky J, Barbanoj M, Lopez-Villegas D, Hernandez G, Pascual-Sedano B. A randomized placebo-controlled comparative trial of gabapentin and propranolol in essential tremor. Arch Neurol. 1999;56:475–80.

    Article  CAS  PubMed  Google Scholar 

  21. Ondo W, Hunter C, Vuong KD, Schwartz K, Jankovic J. Gabapentin for essential tremor: a multiple-dose, double-blind, placebo-controlled trial. Mov Disord. 2000;15:678–82.

    Article  CAS  PubMed  Google Scholar 

  22. Pahwa R, Lyons K, Hubble JP, et al. Double-blind controlled trial of gabapentin in essential tremor. Mov Disord. 1998;13:465–7.

    Article  CAS  PubMed  Google Scholar 

  23. Jefferson D, Jenner P, Marsden CD. Beta-adrenoreceptor antagonists in essential tremor. J Neurol Neurosurg Psychiatry. 1979;42:904–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Koller WC. Nadolol in essential tremor. Neurology. 1983;33:1076–7.

    Article  CAS  PubMed  Google Scholar 

  25. Huber SJ, Paulson GW. Efficacy of alprazolam for essential tremor. Neurology. 1988;38:241–3.

    Article  CAS  PubMed  Google Scholar 

  26. Gunal DI, Afsar N, Bekiroglu N, Aktan S. New alternative agents in essential tremor therapy: double-blind placebo-controlled study of alprazolam and acetazolamide. Neurol Sci. 2000;21:315–7.

    Article  CAS  PubMed  Google Scholar 

  27. Biary N, Koller W. Kinetic predominant essential tremor: successful treatment with clonazepam. Neurology. 1987;37:471–4.

    Article  CAS  PubMed  Google Scholar 

  28. Biary N, Bahou Y, Sofi MA, Thomas W, al Deeb SM. The effect of nimodipine on essential tremor. Neurology. 1995;45:1523–5.

    Article  CAS  PubMed  Google Scholar 

  29. Brin MF, Lyons KE, Doucette J, et al. A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor. Neurology. 2001;56:1523–8.

    Article  CAS  PubMed  Google Scholar 

  30. Jankovic J, Schwartz K, Clemence W, Aswad A, Mordaunt J. A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor. Mov Disord. 1996;11:250–6.

    Article  CAS  PubMed  Google Scholar 

  31. Pahwa R, Busenbark K, Swanson-Hyland EF, et al. Botulinum toxin treatment of essential head tremor. Neurology. 1995;45:822–4.

    Article  CAS  PubMed  Google Scholar 

  32. Hertegard S, Granqvist S, Lindestad PA. Botulinum toxin injections for essential voice tremor. Ann Otol Rhinol Laryngol. 2000;109:204–9.

    Article  CAS  PubMed  Google Scholar 

  33. Warrick P, Dromey C, Irish JC, Durkin L, Pakiam A, Lang A. Botulinum toxin for essential tremor of the voice with multiple anatomical sites of tremor: a crossover design study of unilateral versus bilateral injection. Laryngoscope. 2000;110:1366–74.

    Article  CAS  PubMed  Google Scholar 

  34. Pahwa R, Lyons KE, Wilkinson SB, et al. Comparison of thalamotomy to deep brain stimulation of the thalamus in essential tremor. Mov Disord. 2001;16:140–3.

    Article  CAS  PubMed  Google Scholar 

  35. Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000;342:461–8.

    Article  CAS  PubMed  Google Scholar 

  36. Won E, Ellamushi HE, Samadani U, Baltuch GH. Essential tremor: patient selection, technique, and surgical results. In: Baltuch GH, Stern MB, editors. Surgical management of movement disorders. Boca Raton: Taylor & Francis Group; 2005. p. 111–21.

    Chapter  Google Scholar 

  37. Gross RE, Krack P, Rodriguez-Oroz MC, Rezai AR, Benabid AL. Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson’s disease and tremor. Mov Disord. 2006;21 Suppl 14:S259–83.

    Article  PubMed  Google Scholar 

  38. Koller WC, Lyons KE, Wilkinson SB, Troster AI, Pahwa R. Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor. Mov Disord. 2001;16:464–8.

    Article  CAS  PubMed  Google Scholar 

  39. Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology. 1998;51:1063–9.

    Article  CAS  PubMed  Google Scholar 

  40. Rehncrona S, Johnels B, Widner H, Tornqvist AL, Hariz M, Sydow O. Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord. 2003;18:163–70.

    Article  PubMed  Google Scholar 

  41. Diamond A, Jankovic J. The effect of deep brain stimulation on quality of life in movement disorders. J Neurol Neurosurg Psychiatry. 2005;76:1188–93.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Hariz GM, Blomstedt P, Koskinen LO. Long-term effect of deep brain stimulation for essential tremor on activities of daily living and health-related quality of life. Acta Neurol Scand. 2008;118:387–94.

    Article  PubMed  Google Scholar 

  43. Carpenter MA, Pahwa R, Miyawaki KL, Wilkinson SB, Searl JP, Koller WC. Reduction in voice tremor under thalamic stimulation. Neurology. 1998;50:796–8.

    Article  CAS  PubMed  Google Scholar 

  44. Obwegeser AA, Uitti RJ, Turk MF, Strongosky AJ, Wharen RE. Thalamic stimulation for the treatment of midline tremors in essential tremor patients. Neurology. 2000;54:2342–4.

    Article  CAS  PubMed  Google Scholar 

  45. Binder DK, Rau GM, Starr PA. Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery. 2005;56:722–32; discussion 722–732.

    Article  PubMed  Google Scholar 

  46. Baizabal Carvallo JF, Simpson R, Jankovic J. Diagnosis and treatment of complications related to deep brain stimulation hardware. Mov Disord. 2011;26:1398–406.

    Article  PubMed  Google Scholar 

  47. Obwegeser AA, Uitti RJ, Witte RJ, Lucas JA, Turk MF, Wharen Jr RE. Quantitative and qualitative outcome measures after thalamic deep brain stimulation to treat disabling tremors. Neurosurgery. 2001;48:274–81; discussion 281–274.

    CAS  PubMed  Google Scholar 

  48. Anderson WS, Lenz FA. Surgery insight: deep brain stimulation for movement disorders. Nat Clin Pract Neurol. 2006;2:310–20.

    Article  PubMed  Google Scholar 

  49. Kondziolka D, Ong JG, Lee JY, Moore RY, Flickinger JC, Lunsford LD. Gamma knife thalamotomy for essential tremor. J Neurosurg. 2008;108:111–7.

    Article  PubMed  Google Scholar 

  50. Niranjan A, Jawahar A, Kondziolka D, Lunsford LD. A comparison of surgical approaches for the management of tremor: radiofrequency thalamotomy, gamma knife thalamotomy and thalamic stimulation. Stereotact Funct Neurosurg. 1999;72:178–84.

    Article  CAS  PubMed  Google Scholar 

  51. Elias WJ, Huss D, Voss T, et al. A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2013;369:640–8.

    Article  CAS  PubMed  Google Scholar 

  52. Jankovic J, Cardoso F, Grossman RG, Hamilton WJ. Outcome after stereotactic thalamotomy for parkinsonian, essential, and other types of tremor. Neurosurgery. 1995;37:680–6; discussion 686–687.

    Article  CAS  PubMed  Google Scholar 

  53. Mohadjer M, Goerke H, Milios E, Etou A, Mundinger F. Long-term results of stereotaxy in the treatment of essential tremor. Stereotact Funct Neurosurg. 1990;54–55:125–9.

    Article  PubMed  Google Scholar 

  54. Nagaseki Y, Shibazaki T, Hirai T, et al. Long-term follow-up results of selective VIM-thalamotomy. J Neurosurg. 1986;65:296–302.

    Article  CAS  PubMed  Google Scholar 

  55. Niranjan A, Kondziolka D, Baser S, Heyman R, Lunsford LD. Functional outcomes after gamma knife thalamotomy for essential tremor and MS-related tremor. Neurology. 2000;55:443–6.

    Article  CAS  PubMed  Google Scholar 

  56. Siderowf A, Gollump SM, Stern MB, Baltuch GH, Riina HA. Emergence of complex, involuntary movements after gamma knife radiosurgery for essential tremor. Mov Disord. 2001;16:965–7.

    Article  CAS  PubMed  Google Scholar 

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Rana, A.Q., Chou, K.L. (2015). Treatment of Essential Tremor. In: Essential Tremor in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-14598-3_5

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  • DOI: https://doi.org/10.1007/978-3-319-14598-3_5

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  • Publisher Name: Springer, Cham

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