- 1 What is essential tremor?
- 2 Essential tremor symptoms
- 3 What causes shaking and tremors?
- 4 Tremor in hands. Hand shaking tremors
- 5 Medicine for tremors. How to treat essential tremors
- 6 Beta blockers and tremors. Drugs for essential tremor
- 7 Propranolol (Inderal) dosage for tremors. Anti-tremor medication
- 8 How to stop shaking from anxiety?
- 9 Essential tremor and alcohol
- 10 Treatment for tremors in elderly
- 11 Essential tremors diet
What is essential tremor?
Essential tremor is one of the most common diseases of the nervous system that is manifested in the form of the smooth shaking of extremities and head. The tremor may affect the vocal chords, and other parts of the body.
The disease is often developed in people of old age, over 60, however, the disease grows younger within the past 10 years. This diagnosis is found in patients at the age of 50, and over.
The essential tremor is often confused with Parkinson’s disease. The semiology is similar but these are completely different pathologies with various origin of the development. Parkinson’s disease is well studied and there are many causes why this disease develops. The essential tremor is not studied well because scientists still do not understand the basic causes of the development of this pathology.
A peculiarity of the essential tremor is that trembling of the body parts is increased during doing any action. The tremor appears during the static tension, or during any purposive movements. And so, the essential tremor is called as a movement tremor. This is the difference from Parkinson’s disease when tremor is kept even at rest.
- WHO do not have exact data about the spread of the essential tremor.
- According to the results of 34 studies in the USA, about 7 million citizens have the essential tremor.
- The essential tremor is not dangerous for the life, but 86% of respondents have stated that the disease influences on their life, and they have to adjust the standard plans.
Essential tremor symptoms
A main symptom of the essential tremor is a moderate amplitude trembling of the body parts when the increase of the muscle fibers is absent. The rhythmical muscle contractions are uncontrolled, and the tremor is continued till a patient is relaxed.
The disease can progress. If the symptoms appear just during the tension of the muscles at first, then as a result of the disease progress, there is a risk of the tremor development at rest. However, this is possible only during the absence of the treatment.
According to the estimations of the clinical studies where more than 1 600 patients with the essential tremor took part, the symptoms often touch the upper extremities:
- 90% of patients have the tremor of arms, and fingers;
- 30% of patients have the tremor of the head;
- 20% of patients have the tremor of the vocal chords;
- 10% of patients have the tremor of the lower extremities, jaw, and separate parts of the face.
What causes shaking and tremors?
Despite a broad spreading of the disease all over the world, the scientists still cannot know a root cause of the essential tremor development. It is assumed that the disease develops as a result of the pathological disorders in the nervous system. However, it is impossible to detect a site of the pathological changes in every clinical case. The disease is probably activated in the brain during the changes of the functions or a structure of separate neurons. However, neurovisualization does not detect a pathology in patients with the intensive semiology.
As of today, there are not special diagnostic tests to confirm the diagnosis of the essential tremor. Therefore, most scientists believe that this pathology has a genetic origin. The gene responsible for the development of the tremor is unknown yet but if a person has direct close relatives with this disease, a risk of the tremor is by 50% higher. Moreover, the symptoms develops at early age. It means, if your father or mother has the essential tremor, there is a chance that you will have the progress of the disease at 70, 55, or 60.
But you should know that a deficit of knowledge about the essential tremor may bother a diagnosis. This way, before diagnosis, it is necessary to take the blood test to eliminate other diseases manifested by the tremor.
Tremor in hands. Hand shaking tremors
According to the various estimations of the WHO specialists, the hand shaking tremor is observed in 8-17% of population. It is the most common neurological disorder in people of old age, and it is hardly treatable.
The tremor begins from hands in 99% of patients. It is impossible to explain such mechanism of the disease development. There is an assumption that the hand shaking tremor is related to the nerve endings on the hands, and hands are involved in most human activities.
The load on the muscle and ligamentous apparatus of the upper extremities is higher, and so the nervous system intensively reacts. And the tremor starts from hands during most diseases.
Admittedly, that shaking of the upper extremities appears not only during the essential tremor, but also during:
- Parkinson’s disease;
- Multiple sclerosis;
- Abstinent syndrome;
- Degenerative diseases of the nervous system.
So, it is necessary to know a cause of this disorder during the development of the hand shaking, and then any therapeutic measures are taken. The hand tremor progresses slowly but it is impossible to cure of the disease. There is a high chance of the complete recovery only during the neurosis and alcoholism. The hand tremor is not treated during Parkinson’s disease, multiple sclerosis, and essential tremor. However, the progress of the disease can be slowed down.
Medicine for tremors. How to treat essential tremors
There are drugs at the moment slowing the progress of the essential tremor and reducing its intensity.
It is important to stress that despite a rather soft progressing of shaking, the treatment of the essential tremor should be done because the shaking may progress faster in patients at old age, and it sometimes bothers a self-care in the common life, not to speak of the professional activity.
It is recognized that high doses of vitamin B6 favor the gradual slowing of the shaking progress during the essential tremor. It may be used in the form of the intramuscular injections (from 4 to 8 ml 5% solution a day).
B vitamins (1; 6; 12) support the health of the nervous system, help to lower the agitation of the neurons. Patients are given injections with vitamins, within 30 days, 2 times a year. The interval between the therapeutic cycles should be at least 6 months.
Dr. Gregg Reger, MD: The beta-blockers (Propranolol) significantly reduce a range of the shaking and an intensity of the tremor symptoms: they are used for a long period, 10-20 mg 2 times a day. The treatment may last within 1-2 years and even more.
But it is necessary to regularly control the pulse and the blood pressure during the treatment because the group of the beta-blockers can reduce the frequency of the heart beats and lower the blood pressure.
The anti-seizure drugs take a special place in the treatment of the essential tremor. The treatment is usually continued within several years because this group of the drugs acts symptomatically and does not have a prolonged action. It means that the effect disappears at once after the termination of the tablet application.
Doctors pay a special attention to some anticonvulsants to treat the essential tremor. These anticonvulsive drugs block the muscle spasms of the various origin. Some representatives of this medication group can stop a shaking of the extremities or reduce the symptoms.
The treatment of the essential tremor is possible only pharmaceutically. The treatment will be symptomatic and a patient will be offered the treatment for life. However, a range of the medical products including beta-blockers are allowed for the use within a long period and do not have side effects. Bear in mind that refused treatment may accelerate the tremor development.
Beta blockers and tremors. Drugs for essential tremor
One of the last clinical studies have indicated that the intensity of the essential tremor symptoms may depend on the level of the agitation of beta-adrenoceptors. The higher the activity of the noradrenergic system, the more the hand shaking will be. Due to this, the group of the beta-blockers has become a gold standard in the treatment of the essential tremor.
Propranolol is often used in the clinical practice, even though its main task is to treat the arrhythmia and blood pressure. As Propranolol is a non-selective beta-blocker, it provides a wider action:
- Lowering the activity of the nervous system;
- Restoring the normal breathing and pulse;
- Reducing the anxiety, fear, that is a trigger of the tremor.
All these effects help to achieve one goal – to reduce unintentional shaking of the head and extremities.
Besides Propranolol, other beta-blockers are used for the treatment of the essential tremor: Metoprolol and Atenolol. As Atenolol is a selective beta-blocker, it is able to reduce a reaction of the nervous system.
Propranolol (Inderal) dosage for tremors. Anti-tremor medication
The dosage of Propranolol (Inderal) in the treatment of the essential tremor depends on many factors. It may vary from 10 mg a day to up to 320 mg a day and depends on the clinical presentation of a patient.
- To treat the essential tremor, Propranolol (Inderal) is prescribed in the initial dose of 40 mg per day.
- The pills are taken once a day, at the same time, regardless of meals.
Twelve clinical studies confirmed the efficiency of Propranolol (Inderal) during the tremor of the extremities have stated that the dose less than 40 mg is ineffective.
- The optimal dosage starts from 80 mg a day.
- If severe types of the tremor and concomitant diseases, the dose is increased up to 120-240 mg a day. High doses are taken 2-3 times with the same interval.
If a patient has symptoms of bradycardia or a low blood pressure during the treatment, the dose of Propranolol (Inderal) may be reduced up to 10-20 mg a day. If this low dose did not cause the improvement of the tremor symptoms within a week, it is necessary to replace the drug, or change a scheme of the treatment.
How to stop shaking from anxiety?
About 40 million citizens of the USA at the age of over 18 experience anxiety on a regular basis. Every third of them have shaking during the attack of the anxiety and concern. Shaking appeared during fear and anxiety is not dangerous but causes a lot of discomfort. It is related to the high release of adrenalin in the blood, so that a stimulation of the beta-adrenoceptors happens, and it provides the whole physiological action on the body. Due to the stimulation of these receptors, the pulse, the blood pressure grows during the fear and anxiety, a lack of oxygen and even sweatiness appear. Tremor also appears because of these causes.
The best way to stop shaking during the anxiety is to learn to cope with the symptoms of the anxiety and fight a fear. A cognitive behavioral therapy is the main tool to cope with the tremor during the anxiety. But it is rather difficult to control it, and so if you want to control yourself, it is better to use options on the pharmaceutical market.
- Benzodiazepines are sedative products that help to relax, clean the mind and calm down the body. It quickly inhibits the concern and panic.
- Beta-blockers inhibit beta-adrenoceptors and reduce their action on the body. Unlike benzodiazepines, they act not on the neurotransmitters in the brain, but on the cardiovascular system. Beta-blocker Propranolol quickly inhibits the symptoms related to the anxiety (tachycardia, arrhythmia, hypertonia), and also reduces the hand tremor.
Dr. Gregg Reger, MD: But if you prefer beta-blockers, it is necessary to learn how to cope with your emotions. Propranolol does not inhibit the anxiety and is not able to reduce the panic.
Essential tremor and alcohol
Some people state a unique peculiarity: the tremor disappears after a consumption of little of alcohol. It is true, alcohol can help to cope with the tremor but only if this tremor is caused by the abstinent syndrome.
Tremor in alcoholics is a common symptom which is accompanied by the abstinent syndrome. The tremor passes after the alcohol consumption. But in case of the essential tremor, an alcohol consumption is not recommended. In case of this disease, a consumption of alcohol may help to relieve the tremor for a while. The effect lasts for up to 1-1,5 hours, and then a “kickback” effect occurs. The symptoms of the essential tremor grow during this effect.
If the alcohol is consumed for a long period, it will worsen the semiology and accelerate the disease aggravation. Ethanol is the main enemy of the nervous system that affects the cells and breaks a link between neurons. The worse the link between neurons is, the worse the electric impulses are transferred to the muscle fibers, and it may cause uncontrolled shaking.
Treatment for tremors in elderly
An intensity of the tremor grows with the increase of the human age. Elder people have more causes of the tremor in comparison to young ones. It happens because most old people have unstable nervous system. It again confirms the fact that the essential tremor has not only a genetic origin, but it is also related to the work of the nervous system.
There is an opinion that tremor in elderly people is accompanied with a decrease of the cognitive function, and there are no confirmations of this fact. In any case, shaking will progress, if not treated. Even if you are 70 and you think that the tremor does not cause any discomfort, you are wrong.
The shaking of the extremities, head, and face changes the plans every day and bothers a normal life. As old people have more intensive tremor, the treatment should be complex and targeted. Unfortunately, many effective products for the treatment of the essential tremor are not available for old people. Some of them have hypotension, bradycardia, or other symptoms of the cardiovascular diseases.
- Beta-blockers lower the blood pressure and reduce the pulse, and so they will not do.
- 9 out of 10 benzodiazepines are contraindicated elder people because this agent affects the central nervous system, and so it may cause disorders. The side effects of the benzodiazepines appear in patients at the age of over 60 more often by 65%.
So, elder people are equipped with vitamin-mineral complexes and anticonvulsive medications. But if the blood pressure is normal, or increased, patients may be prescribed Propranolol. However, the average dose should be by 50% lower than the standard one.
Essential tremors diet
A contribution of food to the health of the central nervous system is more than you think. Many pathological disturbances in the nervous system including the affection of the neurons is possible due to the deficit of vitamins and minerals in your nutrition.
Following a special diet will help to set the work of the nervous system, and relieve the symptoms of the essential tremor.
Some food rules during the essential tremor are:
- Forget about the coffee and green tea. It is great enhancers that may just increase the tremor.
- Decrease a consumption of sugar but do not refuse from it fully. Glucose is a nutrition for the brain. A lack of sugar may cause irritation, make you more vulnerable to stress, and this is the first step for the tremor aggravation.
- Forget about the hunger. Hypoglycemia during hunger causes tremor, headache, and nausea. Divide the daily ration into 4-5 parts, and eat with the interval of 4 hours.
Take more food rich in B vitamins (walnuts, almond, avocado, cashew, chia seeds, pumpkin, etc.), potassium (banana, sesame seeds), and magnesium (sea cabbage, beans, hazel nuts, garlic).
Improving the cardiovascular system and the central nervous system, there is a chance that the tremor development will be lower. And if you faced the negative symptoms, healthy eating will probably help to relieve the sufferings and cope with the tremor.