brain, spinal cord, and nerve disorders
Tremor
Treatment of Tremor
Any specific cause of the tremor is treated when possible—for example, by stopping a drug that is causing the tremor or by treating hyperthyroidism. Parkinson disease can be treated with Treatment . Formild tremor,no treatment is needed. If tremors become bothersome, some simple measures can help: Grasping objects firmly and holding them close to the body to avoid dropping them Avoiding uncomfortable positions Avoiding other circumstances that trigger the tremor (such as consumption ofcaffeine, lack of sleep, or fatigue) Using assistive devices, as instructed by an occupational therapist Assistive devices may include rocker knives, utensils with large handles, and, particularly if the tremor is severe, button hooks, Velcro fasteners (instead of buttons or shoe laces), zipper pulls, straws, and shoe horns. Certain drugs (see table Some Causes and Features of Tremor ) can cause or aggravate different types of tremor. Alcohol and other sedatives, sometimes only when given in low doses, may suppress essential and physiologic tremor. Eliminating or minimizing the trigger may lessen physiologic tremor. For example, avoidingcaffeine, getting enough sleep, and minimizing stress may help. If many daily activities (such as using utensils and drinking from a glass at mealtime) become difficult or if the person's work requires steady hands, drug therapy may help. People with a physiologic tremor and anxiety may benefit from taking a low dose of a benzodiazepine (a sedative), such aslorazepam. However, these drugs should be taken only occasionally. (a Adrenergic blockers ) may help. For some people, drinking alcohol in moderation may lessen the tremor, but doctors do not recommend this tactic as a treatment. Heavy drinking followed by suddenly stopping makes the tremor worse. Antiseizure drugs (primidone,topiramate, orgabapentin) orpropranololmay also be used if needed to control the tremor. Benzodiazepines may be used to treat essential tremor if other drugs are ineffective. Intention tremors are difficult to treat, but if the condition causing it can be corrected, the tremor may resolve. If the condition cannot be corrected, a therapist may put wrist and ankle weights on the affected limb to reduce the tremor. Or people may be taught to brace the limb during activity. These measures sometimes help. For this procedure, tiny electrodes are placed in the area of the brain involved in tremors—the basal ganglia (collections of nerve cells that help smooth out muscle movements). The electrodes send small amounts of electricity to the specific area of the basal ganglia responsible for the tremors and thus help relieve symptoms. Deep brain stimulation is sometimes done when drugs cannot control a severe, disabling tremor. Sometimes essential tremors or tremors due to Parkinson disease or another disorder require such treatment. Such treatments are used only when drug therapy has been tried and has been not been effective. These treatments are available only at special centers. 