Can essential tremor be cured? Choosing the right method is important

Essential tremor is a familial genetic disease. The tremor experienced by many patients is mild, and only a small number of patients need treatment. Alcohol therapy can be chosen for treatment. The tremor of the patient will be significantly relieved after drinking a small amount of alcohol, but it must also be combined with drug treatment.

1. Alcohol: Tremors in most patients can be temporarily and significantly relieved after drinking a small amount of alcohol, but as time goes on, they may need to drink more to achieve the same therapeutic effect. Patients are advised to drink a small amount of alcohol before meals or before participating in social activities to reduce tremors.

2. β-adrenergic blocking drugs

It works by blocking peripheral β2 receptors. Propranolol (Inderal) can reduce the amplitude of tremors but has no effect on the frequency of tremors. It needs to be taken for a long time. In certain situations, patients with obvious tremors can use it temporarily in advance, 30-90 mg, divided into 3 doses; or use 10 mg of arotinolol, 3 times/day.

Relative contraindications of propranolol include: uncontrolled heart failure; II-III degree atrioventricular block; bronchospasm diseases such as asthma; and insulin-dependent diabetes mellitus, because propranolol can block the normal adrenergic response of diabetic patients to hypoglycemia. Rare side effects include fatigue, nausea, diarrhea, rash, impotence and depression. Most patients can tolerate propranolol (Inderal) well. It is still recommended to monitor pulse and blood pressure during medication. It is usually safe to maintain a pulse of more than 60 beats/min.

3. Antispasmodics and tranquilizers

(1)

Primidone (primidone): It can reduce the amplitude of tremors but does not affect the frequency of tremors. Its mechanism is unknown. It is used to reduce hand tremors but has poor effect on head and tongue tremors. ET patients are often very sensitive to this drug and should not be used to treat epilepsy. Start with a low dose of 50 mg/d and increase the dose by 50 mg/d every 2 weeks until it is effective or side effects occur. Usually the effective dose is 100-150 mg, 3 times/d. To improve medication compliance and reduce drowsiness side effects, it is recommended to take the drug before bedtime. 20% to 30% of patients experience acute side effects such as dizziness, nausea and postural instability after taking the medicine. These side effects are temporary and can be gradually relieved without affecting continued medication.

(2) Antiepileptic drug gabapentin: Its use in the treatment of essential tremor remains controversial. Although several open-label studies have suggested that gabapentin is effective in reducing tremors, a double-blind controlled study did not find it to be any better than placebo.

(3) Neuroleptics: commonly used are phenobarbital, diazepam (Valium), etc. Recent studies suggest that clonazepam may have better therapeutic effects, with the main side effect being drowsiness. Anxiety can aggravate tremors, so it is speculated that the therapeutic mechanism may be related to central sedation.

4. Botulinum toxin A (BTX-A) can effectively reduce tremors of limbs, soft palate, etc., reduce the amplitude of tremors, and has little effect on the frequency of tremors. One observation showed that BTX-A injection into the hand extensor and flexor muscles

After 4 weeks of treatment with 100U, 75% of patients had mild to moderate relief of tremor.