Misunderstood essential tremor

by Margo White / 24 December, 2011
Essential tremor makes little difference to most people with the disorder but it can make life difficult for some.


We all know about the shaking characteristic of high-profile movement disorders, such as Parkinson’s disease, and the DTs that afflict those suffering withdrawal from the booze. Most of us tremble when we are tired, are scared, have had too much coffee or even try to hold our arms in front of us. Shaking, when you think about it, is a common aspect of the human condition.

About 20 different tremor disorders are described in the medical literature, each with their own idiosyncratic causes and manifestations. There is orthostatic tremor, a high-frequency tremor of the legs that occurs when someone is standing still; intentional tremor, which occurs when people go to do something precise, such as touch their nose; and dystonic tremors, involuntary muscle contractions that cause twisting and repetitive movements. Most disorders that cause tremors are rare. And then there is essential tremor, which is extremely common and yet just as misunderstood.

Essential tremor affects the hands and the head, and occasionally the larynx. It also afflicts around 2% of the population, which is a lot of people. Katharine Hepburn had it, which she displayed to great empathetic effect in the 1981 movie On Golden Pond. In the past, people with essential tremor might have been packed off to a shrink because their GP put their trembling hands down to anxiety. Although essential tremor can be worsened by anxiety, fear, excitement or exercise – anything that increases the production of adrenalin – it’s a neurological rather than psychological condition. That is, it’s in the brain rather than the mind.

Common misconceptions about essential tremor are reflected in its former names, such as senile tremor, familial tremor and benign essential tremor. Essential tremor does tend to get worse with age, but has nothing to do with senility; it can turn up in children as young as 10, although is most common in people in their forties and fifties. It has been called familial tremor because it does run in families – although this is not the case for about half the of people who have it.

It was called benign essential tremor because it doesn’t usually correspond with any other neurological problem – for instance, it’s not a precursor to Parkinson’s. For most people it makes little difference to their lives; they might just need to avoid pouring the champagne at Christmas. In some, however, it can be quite debilitating.

“There is nothing benign about it,” says Susan Yoffe, national co-ordinator of the NZ Essential Tremor Support Group, who was diagnosed with the condition 30 years ago when in her late thirties. “Now I can hardly handwrite, I drink through a straw, I have trouble eating …”

Adrenalin-blockers are the pharmacological drug of choice for people with essential tremor, and they work better for some than for others. Curiously and for reasons unknown, one of the most effective treatments for essential tremor is alcohol – a couple of gins before dinner might dampen the tremor for several hours.

This isn’t something the medical fraternity is in a position to actually prescribe, at least not publicly, although doctors might recommend it, at least in moderation. “If someone is going out to a restaurant and they’re worried about it – that the peas are going to go on the floor or if they going to have to have soup – a glass of wine before going out might be quite appropriate,” says neurologist Jon Simcock.

Essential tremor can make all sorts of everyday tasks difficult: holding a cup of tea, getting change out of a wallet, signing one’s name, holding a phone. It can also be embarrassing. People often look at you strangely, probably wondering whether you are suffering from alcohol withdrawal or have something to hide. It pays to be open about your essential tremor, advises Simcock. As he points out, the trembling hands associated with essential tremor occur when the arm is extended, or tense, but stops when people are relaxed and their arms are at rest. “So if people hold their hand, or grip it, and try to prevent other people from seeing it, the worse it gets.”

He encourages people to say something like “don’t mind the tremor” and explain what it is. “So everyone can relax a bit and the person looking at them won’t carry on looking at them.” Yoffe agrees. The support group has a card that explains what essential tremor is and asks for patience, which members can hand out if they need to. But life would be easier if they never had to. “I just wish more people knew about it, so we didn’t have to explain ourselves all the time.”

GETTING THEIR GREENS




Although past research has shown that about 70% of children are sensitive to bitterness, which explains the unpopularity of certain vegetables, a study in the Journal of the American Dietetic Association suggests a low-fat dip might help them get over it. For the study, 152 pre-school children were served broccoli at snack time over a seven-week period with 70g of ranch dressing as a dip. Those with a sensitivity to bitterness increased their broccoli consumption by 80%.

HEAVY ON THE SALT


About two-thirds of adult New Zealanders are consuming more sodium than they should, according to an analysis of urine samples from 3000 people who took part in the latest New Zealand Adult Nutrition Survey. The average sodium intake of New Zealand adults was estimated at about 3.5g a day (9g of salt), compared with the recommended 2.3g (6g of salt). New Zealand men aged 19-44 years had mean intakes almost double the recommended level. Previous research shows 90% of sodium is consumed as salt, about three-quarters of which comes from processed foods.

CUPPA CURE-ALL


A collaboration between scientists at London's Kingston University and British beauty brand Neal's Yard that tested 21 plant extracts for evidence of their efficacy in fighting cancer and ageing found that white tea, witch hazel and rose came up trumps. White tea was the most promising: researchers suggested a cup a day might help reduce risk of cancer, rheumatoid arthritis and even wrinkles.
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