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More on Tremor
More on Tremor
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Neurology and Neuroscience
Tremor, an involuntary, rhythmic movement produced by the contractions of opposing muscles, commonly affects the arms, legs, neck, tongue, chin, or vocal cords. It can occur as a symptom of a neurological disorder such as Parkinson's disease, or of medication use, alcohol consumption or withdrawal, or an overactive thyroid.
Most cases of tremor are due to a condition called essential tremor, which is the most common movement disorder in adults, affecting thirteen million people in the United States. Tremor can occur at any age but is most common in middle-aged and older persons.
In people with essential tremor, the most frequent symptom is "action tremor", tremor that occurs when the affected body part is used to perform activities such as writing, pouring, eating. Essential tremor is usually progressive, and in severe cases people with tremor become very dependent on others to help them carry out their normal activities.
As many as half or more of patients with essential tremor may have inherited a gene for the disorder, which appears to be related to abnormal activity in the cerebellum. This region of the brain integrates information from other brain regions, the spinal cord, and sensory receptors to ensure coordinated, smooth movements. Researchers are working to better define the exact causes of essential tremor.
Diagnosis of Tremor
Neurologists at NewYork-Presbyterian Hospital are expert at accurately diagnosing tremor and helping patients and their families manage complications of the disorder.
Neurologists and neurosurgeons at our two movement disorders centers, Columbia's Center for Parkinson's Disease and Other Movement Disorders or Weill Cornell's Parkinson's Disease and Movement Disorders Institute, conduct a variety of clinical trials in tremor, and we have a large and busy surgical program.
Medical Treatment for Tremor
Medical treatment depends on the underlying cause of tremor, and in most cases there is no cure. Treatment may include:
- Beta blockers, primidone and other drugs for essential tremor.
- Levodopa or dopamine-like drugs for Parkinsonian tremor.
- Intramuscular injections of botulinum toxin for dystonic tremor.
Doctors may also recommend eliminating substances that can trigger tremors including caffeine and other stimulants from the diet.
Surgical Treatment for Tremor
If tremor is severe and does not respond to medical treatment, doctors may consider surgical intervention. Deep brain stimulation (DBS), a surgical procedure pioneered at NewYork-Presbyterian Hospital, has become an important tool in the treatment of tremor. In DBS neurosurgeons implant a device that acts like a pacemaker for the brain. The device reduces or eliminates the activity of the areas overly active in tremor, thereby minimizing symptoms. DBS also enables many patients to reduce their dependence on medications.
Doctors here take special precautions during brain surgery. NewYork-Presbyterian Hospital maintains the most advanced intraoperative neurophysiological monitoring system worldwide. Continuously monitoring the electrical activity of the brain during surgery diminishes the risk of neurological injury.
Rehabilitation for Tremor
Patients with tremor often benefit from physical therapy, which can help improve coordination. Rehabilitation experts at NewYork-Presbyterian Hospital will:
- Evaluate muscle strength and motor skills and develop an individualized program to maintain existing motor function.
- Recommend adaptive devices to help tremor, and canes, walkers, and wheelchairs and equipment for the home if walking and balance are affected.
- Discuss ways to modify activities, conserve energy, and simplify work.
Research for Tremor
Researchers at Columbia's Center for Parkinson's Disease and Other Movement Disorders or Weill Cornell's Parkinson's Disease and Movement Disorders Institute are conducting studies to find the causes of tremor, treat them, and improve care and management.