What Causes Essential or Benign Tremor & How is it Treated?

Essential or benign tremor is fairly common neurological disorder.¹ It is also known by several other names such as benign tremor, idiopathic tremor, and familial tremor. Essential or benign tremor is the most common neurological movement disorder. This disease most often involves arm tremor, finger tremor, and hands tremor. The cause of essential or benign tremor is rather unknown. Essential or benign tremor sometimes also involves vocal cords tremor and head tremor, especially during eating, writing, and other voluntary body movements.

The underlying cause of essential or benign tremor is unknown. However, it is apparent that many cases of essential or benign tremor are familial. One-half of the essential or benign tremor have an underlying cause in certain genetic mutations. The pattern of inheriting essential or benign tremor is believed to be through autosomal dominant transmission. Although the genetic makeup plays an important role in causing essential or benign tremor, no specific genes that cause it were found till this day. However, the genetic linkage has been approved.

Several researches performed by well-established neurologists have concluded that certain toxins might play an important role in the etiology of this disease. The toxins that mainly cause essential or benign tremor, as well as the parkinson’s disease and several cancers are harmane and harmaline. These neurotoxins greatly affect the severity of tremors one experiences.

Consumption of the foods such as chicken, beef, and pork extensively is also one of the causes of essential or benign tremor. Even if these foods are cooked, they still contain certain neurotoxins that cause essential or benign tremor. Several studies had proved that meat consumers were more likely to have essential or benign tremor than vegeterians and vegans. The high lipid solubility of the neurotoxin harmaline found in beef, pork, and chicken enables it to accumulate in the brain and thus gradually lead to this disease.

Speaking of the pathophysiology of essential or benign tremor, several physiological, clinical, and imaging studies have pointed out the involvement of cerebellum and cerebellothalamocortical circuits in the development of essential or benign tremor. Excessive alcohol intake causes changes in the part of the brain called cerebellum which controls movement. Changes in cerebellum sometimes lead to this disease. Certain cells called Purkinje Cells found in cerebellum are sensitive to alcohol excitotoxicity. Impairment of these cells and its synapses leads to cerebellar degradation which leads to essential or benign tremor. The formation of cells called Lewy Bodies in Locus Ceruleus also leads to this. The cases of essential or benign tremor that had progressed to the parkinson’s disease often times did not originate from the cerebellum.

Speaking of genetic causes, certain post mortem medical studies had shown that certain gene alterations are linked to the development of Essential Tremor. The genes whose alterations might cause essential or benign tremor are LINGO1 gene and HAPT1 gene. In 2012, several toxicological studies have proved that excessive amount of lead in the blood might also cause essential tremor.

The mild cases of this neurological disorder present themselves as the inability to stop one’s hands or tongue from shaking, feeling unable to do simple tasks. Even cutting the paper seems hard for the people with essential or benign tremor.

The most common symptoms that might point out that a person suffers from essential or benign tremor are:

• Shaking voice is a primary symptom of essential or benign tremor.
• Tremors that worsen with moving on purpose.
• Head nodding.
• Uncontrollable shaking that occurs daily.
• Problems with balance.
• Tremors that get worse during the times of emotional stress.

There are numerous types of tremors but the two most common types of tremor are essential or benign tremor and Intention Tremor. Although somewhat similar to each other, essential or benign tremor and intention tremor have certain aspects that help medical professionals differentiate on from another.

Essential or benign tremor is most commonly inherited through an autosomal dominant way. Intention Tremor is not inherited. Their cause is a cerebellar lesion that might have occurred after a stroke, Creutzfeldt–Jakob Disease, Fragile X Syndrome, Guillain–Barré syndrome and other disorders.

Essential or benign tremor occurs when a person who suffers from it is doing something. On the other hand, persons with intention tremor get tremors when they try to reach out for an object and thus the name Intention Tremor. Person has an intention to reach out for something but cannot accomplish it.

The most common life decade when one is diagnosed with essential or benign tremor is the 4th life decade. On the other hand, people intention tremors get their diagnosis in their 50s.

Essential or benign tremor can be diagnosed by an experienced clinician while Intention Tremor has to be diagnosed by a MRI or CT scan.

Essential or benign tremor greatly differs from the parkinson’s disease. However, this disorder often comes accompanied with parkinson’s disease or is misdiagnosed for a parkinson’s disease. Let us see what are some of the differences between essential or benign tremor and parkinson’s disease:

• Essential or benign tremor in most of the instances affects head and neck movement. It also affects the voice. On the other hand, head tremor is very uncommon in parkinson’s disease.
• Essential or benign tremor makes its sufferer even feel worse tremor while moving the body parts under tremor. The other way around, people with parkinson’s disease usually feel better when they move body parts affected by tremors.
• Parkinson’s disease tremor is slower than essential or benign tremor.
• Drinking alcohol usually helps the patients who have essential or benign tremor stop their tremor. On the other hand, alcohol does not help at all people with parkinson’s disease.
• Essential or benign tremor does not respond to the treatment which consists of receiving Levodopa. Tremor of parkinson’s disease is immediately stopped after receiving a dose of Levodopa. Propranolol and Pirimidone are used for the treatment of essential or benign tremor.

Essential or benign tremor can happen at any age but it most commonly affects men in their 40s. From reading this article, if you suspect that someone in your family has essential or benign tremor, you should appoint it to a family physician.

This disorder does not require some special tests and can even be diagnosed within five minutes by an experienced neurologist. Diagnosing this condition involves taking your medical history, your family’s medical history, and your symptoms. Also, a physical exam will be performed on you or your family member with a suspected essential or benign tremor.

The ways essential or benign tremor is diagnosed are by:

• Neurological examination.
• Laboratory tests.
• Performance tests.

While performing a neurological exam, your family physician looks how well your nervous system is functioning. That includes checking your tendon reflexes, gait, posture, coordination, muscle tonus and strength.

For a doctor to evaluate the tremor itself, he/she must order you to indulge into a performance test. Your doctor might order you to drink from a glass, draw a spiral, write or hold your arms stretched.

Not all of the cases of essential or benign tremor require treatment. However, there are many treatment options depending on the severity of essential or benign tremor.
The first-line medications used for treating essential or benign tremor are certain beta blockers such as nadolol, propranolol, and timolol. Beta blocker pindolol is not effective in treating essential or benign tremor. First-line anti-epileptic primidone showed to be effective in the treatment of essential or benign tremor.

Second-line meds and third-line meds are used for the treatment of essential or benign tremor if first-line medications are not effective in the treatment of essential or benign tremor. Second-line meds used for treating essential or benign tremor include gabapentin, topiramate, and alprazolam. Third-line medications used to treat essential or benign tremor are mirtazapine and clozapine.

If the medications do not help with treating essential or benign tremor, deep brain stimulation and botolinum toxin are used for treating it.

There is no recovery period for essential or benign tremor since once you get it; you cannot get rid of it. Luckily, certain medications are so powerful that they make you feel like you do not have essential or benign tremor and never experience any tremors.

The medical professionals have long time ago concluded what are the risk factors for one person to develop Essential Tremor. The two main risk factors regarding essential or benign tremor are:

• Genetic mutation.
• Age.

Whether you know it or not, essential or benign tremor can be passed from a parent to a child. The genetic pattern of inheriting this neurological disorder is autosomal dominant inheritance. That makes essential or benign tremor an autosomal dominant disorder. Only one mutated gene in the parent’s genetic structure is enough to make a person suffer from Essential Tremor later in its life.

If you have a parent that was diagnosed with essential or benign tremor, you have a 50% for developing that neurological disorder yourself. The most common genetic mutations that cause essential or benign tremor are the mutations of the genes such as LINGO1 and HAPT1.

If you are 40 years or less old, you do not have to worry at all about developing essential or benign tremor. This neurological illness only affects the people 40 years or above old.

Just like any other disease essential or benign tremor has certain complications. Down below, you will have an insight to the most common complications of essential or benign tremor:

• Inability to eat normally.
• Spilling any cup of tea or coffee.
• Shaving problems.
• Putting on makeup issues.
• Writing problems.
• Inability to speak.

The hardest cases of essential or benign tremor make essential and most common life activities extremely hard for the people with this neurological disorder.

Individuals which were diagnosed with having essential or benign tremor should stop with the caffeine intake because it usually worsens the tremor. Also, they should avoid stress since stress can induce tremor attacks. People with essential or benign tremor should at least sleep 8 hours per day.

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