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TREMORS TREATMENTS |
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Neither tremor nor most of its
underlying causes can be cured. Most people with essential tremor
respond to drug treatment, which may include propranolol, primidone,
or a benzodiazepine. People with Parkinson's disease may respond to
levodopa or other antiparkinson drugs. Research has shown that about 70% of patients treated with botulinum toxin A (Botox) have some improvement in tremor of the head, hand, and voice. Botulinum is derived from the bacterium Clostridium botulinum. This bacterium causes botulism, a form of food poisoning. It is poisonous because it weakens muscles. A very weak solution of the toxin is used in cases of tremor and paralysis to force the muscles to relax. However, some patients experience unpleasant side effects with this drug and cannot tolerate effective doses. For other patients, the drug becomes less effective over time. About half of patients don't get relief of tremor from medications at all. Tremor control therapy Tremor control therapy is a type of treatment using mild electrical pulses to stimulate the brain. These pulses block the brain signals that trigger tremor. In this technique, the surgeon implants an electrode into a large oval area of gray matter within the brain that acts as a relay center for nerve impulses and is involved in generating movement (thalamus). The electrode is attached to an insulated wire that runs through the brain and exits the skull where it is attached to an extension wire. The extension is connected to a generator similar to a heart pacemaker. The generator is implanted under the skin in the chest, and the extension is tunneled under the skin from the skull to the generator. The patient can control his or her tremor by turning the generator on with a hand-held magnet to deliver an electronic pulse to the brain. Some patients experience complete relief with this technique, but for others it is of no benefit at all. About 5% of patients experience complications from the surgical procedure, including bleeding in the brain. The procedure causes some discomfort, because patients must be awake while the implant is placed. Batteries must be replaced by surgical procedure every three to five years. Other surgical treatments A patient with extremely disabling tremor may find relief with a surgical technique called thalamotomy, in which the surgeon destroys part of the thalamus. However, the procedure is complicated by numbness, balance problems, or speech problems in a significant number of cases. Pallidotomy is another type of surgical procedure sometimes used to decrease tremors from Parkinson's disease. In this technique, the surgeon destroys part of a small structure within the brain called the globus pallidus internus. The globus is part of the basal ganglia, another part of the brain that helps control movement. This surgical technique also carries the risk of disabling permanent side effects. Fetal tissue transplantation (also called a nigral implant) is a controversial experimental method to treat Parkinson's disease symptoms. This method implants fetal brain tissue into the patient's brain to replace malfunctioning nerves. Unresolved issues include how to harvest the fetal tissue and the moral implications behind using such tissue, the danger of tissue rejection, and how much tissue may be required. Although initial studies using this technique looked promising, there has been difficulty in consistently reproducing positive results. Small amounts of alcohol may temporarily (sometimes dramatically) ease the shaking. Some experts recommend a small amount of alcohol (especially before dinner). The possible benefits, of course, must be weighed against the risks of alcohol abuse. |
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