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Essential tremors?
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Essential tremors?


  I am a massage therapist and treating a 79 year old female with stage IV Lymphoma with stable disease for her head tremors. She has experienced them for the last 3 years. I have some questions regarding her tremors.
  What medication and/or other treatment can you suggest? What is the etiology? Could these tremors be essential tremors? Can you recommend further reading? Thank you for your help.  N. Miller
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Head tremors could be essential tremor, though I'm surprised it would wait until 76 to show up. Perhaps the tremor was subclinical and then emerged in the setting of the lymphoma or treatment thereof. The etiology of essential tremor is unknown, though in many patients there is a familial component.
Alternately, head tremor could represent dystonia. Typically, one expects dystonia to result in abnormal postures (eg head rotated to one side, as in torticollis, or tilted, as in laterocollis). But sometimes the dystonic movements can look tremor-like. Dystonia is often idiopathic, but sometimes is related to strokes, tumors, medications, etc.
There is the possibility that what is being called a head tremor is in reality a jaw tremor, in which case suspicion would be high for Parkinson's disease. However, a "pure" head tremor is usually not Parkinson's.
For accurate diagnosis, there is no substitute for seeing an experienced neurologist (my bias is that she should see a movement disorder specialist) - at a glance, and with just a few maneuvers on physical exam, the doctor should be able to tell what it is.
Treatment depends on what it is. Consider clonazepam, primidone, propranolol.
Hope this helps. As you know, this information is posted for general medical information. Specific comments regarding diagnosis, treatment options, and prognosis must come from your doctor after appropriate evaluation. CCF MD mdf.





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