Among the various maladies associated with aging, tremors of the hands, arms, head or other body parts can be especially troublesome. Imagine buttoning a shirt or drinking a cup of tea while unable to stop trembling or shaking.
Karen Powers, resident services director of Friendship Village Senior Living Communities, has seen it firsthand. “(Essential tremor) can cause difficulties in fine motor skills, such as writing and eating, as well as getting dressed,” she says. If she notices a tremor is bothering a resident, Powers urges him or her to get the condition assessed so that medical treatment can begin.
Essential tremor often begins in middle age and progresses over time. While physicians know it involves abnormal nerve signals between the brain and muscles, and often runs in families, a specific cause or trigger is elusive. “In medicine, ‘essential’ means ‘of unknown cause,’ ” notes Dr. Daniel Mattson, a neurologist and epileptologist with SSM Neurosciences Institute at DePaul Health Center, where he oversees the Epilepsy Monitoring Unit.
“Essential tremor is an actual disease—it does not just refer to a symptom,” Mattson adds. While tremors may be associated with Parkinson’s disease, stroke, low blood sugar or other specific conditions, essential tremor is not due to any type of injury or illness. Diagnosis involves a complete neurological exam and tests to rule out other potential causes. And although there is no cure for the condition, medications are available to help control the tremor.
“Treatment may not be necessary unless tremors interfere with the patient's ability to perform daily activities,” says Dr. Cheryl Faber, a neurologist with Neurology Associates. “Medications that may reduce tremors include propranolol, Mysoline and other anticonvulsants, and mild tranquilizers. Caffeine in substances such as coffee and soda and other stimulants should be avoided because they commonly worsen tremors.”
Even if a patient cannot tolerate the medicine, Mattson says there is still hope. Deep brain stimulation (DBS) is a surgical procedure that is “almost curative,” but as with any surgery, there are inherent risks and costs. The treatment uses implantable electrodes to send high-frequency electrical signals to the brain, disrupting the abnormal signal that causes the tremor. A wire connects the electrodes to a pacemaker-like device implanted under the skin of the chest that controls the electrical impulses.
Adaptive devices and accommodations also can help patients who have essential tremor. “Our goal is to help residents maximize their potential and enjoy life to the fullest,” Powers says. Physical and occupational therapists and home health professionals can suggest strategies based on individual needs. For example, weighted eating utensils, large mugs for beverages, and hands-free technologies for computer and phone use are among the adaptive devices that may ease frustration.