Treating Essential Tremor.
According to an article published in The New England Journal of Medicine, the first line of treatment of essential tremor involves pharmacotherapy with propranolol or primidone. The information cited also states that "propranolol and primidone are the two compounds with the highest level of evidence to treat essential tremor by reducing the severity of upper-limb symptoms.” If either of the first line treatments are not working effectively individual a combination of the two pharmacotherapies may still be considered. Intervention methods such as deep-brain therapy or focused ultrasound thalamotomy may cause substantial disability. “Although conventional stereotactic thalamotomy was the first available interventional treatment of tremor, its application is limited to unilateral interventions owing to the high risk of irreversible dysarthria or ataxia after bilateral thalamotomy,” according to information cited in a clinical practice article published in The New England Journal of Medicine. According to information cited in a clinical practice article published in The New England Journal of Medicine, “[d]eep-brain stimulation (unilateral and bilateral) and thalamotomy (only unilateral) targeting the thalamic nucleus ventralis intermedius are used for the treatment of medically intractable upper-limb tremor in essential tremor.” Moreover, “[a]dverse events are more common with bilateral than unilateral deep-brain stimulation. Adverse effects of deep-brain stimulation may include reversible stimulation-induced ataxia, dysarthria, paresthesias, tonic muscle contractions, and impaired balance.”
After reading the passage try out this quick quiz game to test your knowledge!
1. Which of the following pharmacotherapies has/have been found to reduce the severity of upper-limb symptoms in patients with essential tremor?
- Primidone
- Propranolol
- A and B
2. True or False. If neither propranolol nor primidone is effective individually in management of essential tremor, combination of these two pharmacotherapies may still be considered for second-line treatment.
- True
- False
3. Which of the following approaches can be used to treat essential tremor that is refractory to pharmacotherapy and has symptoms causing substantial disability?
- Deep-brain stimulation
- MRI-guided focused ultrasound thalamotomy
- A or B
4. True or False. Bilateral stereotactic thalamotomy use in tremor management is not associated with any long-term adverse effects.
- True
- False
5. Which of the following statements is/are TRUE regarding use of deep-brain stimulation in treatment of essential tremor?
- Adverse events are more common with unilateral than bilateral deep-brain stimulation
- Ataxia that is produced as an adverse effect of treatment may be reversible
- When treating medically intractable upper-limb tremor, the thalamic nucleus ventralis intermedius is targeted
- B and C
- A and C
According to information cited in a clinical practice article published in The New England Journal of Medicine, “[d]eep-brain stimulation (unilateral and bilateral) and thalamotomy (only unilateral) targeting the thalamic nucleus ventralis intermedius are used for the treatment of medically intractable upper-limb tremor in essential tremor.” Moreover, “[a]dverse events are more common with bilateral than unilateral deep-brain stimulation. Adverse effects of deep-brain stimulation may include reversible stimulation-induced ataxia, dysarthria, paresthesias, tonic muscle contractions, and impaired balance.”
For complete information, see:
Haubenberger D, Hallett M. Essential tremor. N Engl J Med. 2018;378(19):1802-1810.
Medical Intelligence Quiz. (n.d.). Retrieved from https://www.mdedge.com/neurologyreviews/quiz/7284/movement-disorders/treatment-essential-tremor