Tremor essential

Tremor essential

Essential tremor is a hereditary disease characterized by trembling of the hands, head, and vocal muscles, which increases with movement, an attempt to maintain a certain position and stops when falling asleep. The disease in men usually begins at the age of 50 (in women a little later).

Genetic Aspects

• • Loci 3q 13 (* 190300, 3ql3, genes FET1, ETM1) and 2p25-P22 (* 602134, gene ETM2), R (>50%) were identified
  • Essential tremor with nystagmus and duodenal ulcer (*190310,R).

Clinical picture

• • The disease begins with episodes of rapid (6-12 Hz) paroxysmal (sudden) small-scale tremor of the hands
  • In the future, tremor of the hands, tongue (accompanied by dysarthria), head, legs and torso subsequently develops.
  • Tremor may be unilateral or bilateral, minimal at rest, aggravated by emotional distress, hunger, fatigue, and exposure to extreme temperatures
  • In severe cases, there is a loss of work probability
  • Sometimes tremor is accompanied by mild extrapyramidal disorders in the form of rigidity and gait disturbances, which are much less pronounced than in parkinsonism.
  • Despite impaired workability and possible psychosocial problems, the disease is less severe than parkinsonism, no dementia
  • Often accompanied by dystonia.

Differential Diagnosis

• • Physiological tremor
  • senile tremor
  • Tremor in thyrotoxicosis and alcoholism
  • Tremor in parkinsonism
  • Tremor in cerebellar lesions
  • Tremor during intoxication.

Treatment:

• • Propranolol (anaprilin) ​​20-80 mg 4 r / day (effective also with increased physiological tremor)
  • Primidone 50-250 mg 3 r / day – with ineffectiveness or intolerance to anaprilin
  • Benzodiazepine tranquilizers (diazepam 2–10 mg, lorazepam 1–2.5 mg, oxazepam 10–30 mg orally 3–4 times a day) for increased tremor associated with chronic anxiety
  • A single dose of a small amount of alcohol temporarily reduces the severity of tremor in 50% of patients. The effect begins 10 minutes after administration and lasts 3-4 hours.

Precautions

• • Tolerance and therapeutic dependence develops to benzodiazepine tranquilizers
  • The use of alcohol to reduce tremors can lead to the development of alcoholism.

Synonyms

• • tremor familial
  • Tremor idiopathic
  • Tremor hereditary
  • Tremor idiopathic benign
  • Tremor Essential benign

See also Tremor, Parkinsonism, Parkinson’s disease, Parkinsonism officinalis ICD. G25.0 Essential tremor