Tremors

[sanbart]

I have had essential body tremors for years and take Inderal 60 LA once a day for them.  A few days ago I had to have steroid spinal injections for a herniated disc.  Since then, my back feels better, but the tremors have gotten worse.  Is this a reaction to the steroid and will it continue as long as the medication is in my body?  I don't know which is worse, the terrible back pain or the tremors.  The tremors are visible and can really drive you crazy.  I consulted w/a Neurosurgeon a couple of years ago and was told there is surgery to correct this, but has limitations, i.e., could have a speech slur afterwards.  Please give me some insight into these problems.  Thank you.

[sanbart]

Thank you for answering my concerns.  I am so glad to hear you say that there should be little systemic absorption of the steroid into my body.  It could very well be stress that seems to be intensifying my termors at this time, as I have also had some digestive problems and hypothyroidism.  I consume hardly any caffeine...most would probably be in the form of chocolate

You mentioned seeking advice w/a good center.  The Neurologist I saw was at the University of Michigan.  I am pretty comfortable w/their assessment and I intend to stay in touch w/them.  In my original post, I neglected to mention that about 10 days ago, I had to begin a hypothyroid med, synthroid, 50 mics/day.  Since my back injection and starting the synthroid, I have found my sense of taste to have declined.  Is that a side effect?

Thank you!

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not make specific treatment recommendations however i will try to provide you with some useful information.

Injection of corticosteroids into the epidural space for back pain results in little systemic absorption of the medication into the system, but some absorption can occur, and tremor is a known side effect of corticosteroids. Other potential causes of your tremor worsening may be stress, increased caffiene, or as the result of other medications. If your tremor worsening was related to the steroid injection, this would not be expected to last, because your body will metabolize the systemically-absorbed steroids quickly.

With time, essential tremor worsens, and medications that were once effective at a particular dose may no longer be effective. Regarding treatment options for essential tremor, as you may know the dose of inderal you are on is not that high and it could be increased further if your symptoms are not well controlled. Also, there are several medications that can be used in addition to inderal, many of which are anticonvulsants such as topamax. Discussion of these medication options with your neurologist is recommended; sometimes patients with essential tremor require more than one medication for tremor control.

If medications are not effective, surgery is an option. The surgery involves insertion of electrodes into a specific part of the brain (most commonly a part of the brain called the thalamus, the VIM part, but other areas can be used as well). The electrodes are connected to a device in the chest similar to a pacemaker, and they electrodes are programmed to deliver a specific stimulus into the brain to modulate the activity of the nerve cells. As with every surgical procedure, there are risks associated with procedure. Some are associated with the surgery itself: risk of bleeding in the brain, risk of infection, risk of damage to specific brain structures. Neurologic deficit in that case would be related to part of the brain that was inadvertently damaged: could include speech or swallowing trouble as you mention above, or weakness or sensory loss on one side of the body or the other.

These are not common occurrence and they key factor in mimimizing the risk of the surgery is to have the procedure done in a center that has done many of these procedures (high-volume centers). Other risks are associated with the programming of the device and are often reversible, such as weakness, speech or swallowing trouble etc.

Continued follow-up with your neurologist is recommended. Evalution at a high-volume Movement disorders medical and surgical center (at a teritary care facillity such as a university hospital or multi-specialty center) would allow for you to better understand the risks and benefits of the surgery and your options.

Thank you for using the forum I hope you find this information useful good luck.