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Neurology (Expert Forum)
Best practice/treatment of familial tremor
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Best practice/treatment of familial tremor
by Leslie-Cox-Bourasa, Aug 13, 1998 12:00AM
I (45 yr. old female)have long history (17 years) of essential tremor that manifests with strong pull of head to right and head tremors with few hand/voice tremors. I have treated with propranolol with moderate success. I am wondering what you would consider as being a good candidate for the deep brain stimulation? I have never tried the primidone or clonazepam. Maybe this would be in order first? I appreciate any feedback. Many thanks for your time and consideration.
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I'm not so sure that this is essential tremor. Pulling of your head to one side (the phenomenon is called torticollis) is usually a manifestation of dystonia. Dystonia is an abnormal activation of a group of muscles which results in abnormal posture or sometimes jerking. Dystonia can produce tremor (dystonic tremor).
Dystonia can affect any region of the body, including head, limbs, face. There are many causes, most of which we just don't know. There are forms which run in families.
It's not impossible to have ET and dystonia, but you need to have someone experienced look into this. Typically, this would be a trained movement disorders specialist.
Klonopin, by the way, can be effective for either dystonic or essential head tremor, though not always.
The question of deep brain stimulation (DBS) is a good one. Typically, it is best used for limb tremor, not head tremor or voice tremor. Typically, one would proceed only if the limb tremor was in some way disabling (eg preventing self-care tasks like dressing, bathing, and feeding). The cause of tremor (for example, Parkinson's disease, essential tremor, dystonia, or even MS lesions) may not be as important a factor in determining whether DBS should be considered. Also, no surgeon would proceed unless best medication options had been tried (the drugs you mentioned are on that list).
You are welcome to call 800 223-2273 and ask for 4-5559 (neurology appointments). Tell them you have tremor and maybe dystonia and would like to be seen by a movement disorders specialist.
As you know, this information is posted for your medical education. Specific comments regarding diagnosis, treatment options, and prognosis must come from your doctor after appropriate evaluation. CCF MD mdf.
