Defining The Condition: Parkinsons Vs Essential Tremor
Parkinsons Disease: According to the Parkinsons Foundation, Parkinsons disease is a neurodegenerative disorder that affects predominantly dopamine-producing neurons in a specific area of the brain called substantia nigra. Parkinsons itself is not a fatal disease, however, it can have serious complications that can be.
- At what age does Parkinsons usually manifest? Typically Parkinsons typically manifests in individuals 50 years or older. However, Young Onset Parkinsons , affects 2% to 10% of individuals in the U.S. with Parkinsons.
- What is the prevalence of Parkinsons disease? According to Nih.gov, approximately 1.8% of adults 65 and older suffer from Parkinsons disease.
Essential Tremor: As defined by John Hopkins Medicine, essential tremor disorder is a neurological condition that causes your hands, head, trunk, voice, or legs to shake rhythmically. Generally, these tremors are worse when moving than when at rest. However, tremors can be severe enough to interfere with regular daily activities such as eating, speaking, and even using the restroom independently. Essential tremor is considered benign, or non-life-threatening.
- At what age does essential tremor usually manifest? Essential tremor typically affects individuals over the age of 65, however, it can develop at any age.
- What is the prevalence of essential tremor? According to Nih.gov, approximately 4.67% of adults 65 and older suffer from essential tremor.
Differential Diagnosis Of Et And Tremor Dominant Pd Patients
There is no biomarker for to differentiate the tremors of ET and PD except by clinical assessment. The difficulty with diagnosing early PD has been highlighted in several recent clinical trials, especially with relatively high clinical diagnostic error rates for PD and ET. As reported from multiple clinical studies, about 3050% of ET patients are misdiagnosed as false ET, PD or no ET . While there is no concrete evidence on why there is such poor accuracy in diagnosing ET, it is possible that a certain subtype of ET may be involved in clinical investigations. For example, a subset of ET patients that developed PD over time may express different clinical characteristics and neuropathological features compare to stable ET patients who do not develop PD. A recent study showed that ET-PD patients had fewer widespread postural and/or action tremors or cerebellar signs and required fewer ET medications than stable ET patients . In addition, it is pretty difficult to diagnosis ET when the patients have overlapping tremors with PD, such as resting tremors. Studies showed 19% of ET patients have rest tremors and rigidity while sustained posture tremors are also found in some PD patients . Since ET is reported as a risk of PD and often occurs several years prior to the onset of PD, increasing interest in developing objective measurements, such as brain image and genetic analysis, is critical for early diagnosis of ET and the prevention of PD.
Recommendation For Those With Et
ET, PD and parkinsonism have one thing in common: they dont affect individuals in identical ways. There are accepted diagnostic guidelines, but an infinite number of small or large differences can occur: rate of progression, response to medication, nature of lifestyle problems and impairment, etc. If two persons with ET were to compare notes, they would quickly find that things like propranolol helps one but not the other, or one of them gets terrible restless leg syndrome at night while the other has never had it, etc. Thus, there is a growing theory that ET is not a single disorder, but a group of disorders.
For those with ET who notice that they have additional symptoms that dont fit the classic ET descriptions in books or websites, we recommend discussing the situation with a movement disorder specialist. Perhaps theres no cause for concern, but it may be worth seeking an evaluation to rule out a co-occurring form of parkinsonism. Accurate information may be your best friend, since it both equips you and your doctor to strategize treatment, and also to manage anxiety and gain peace of mind.
iRajput AH, Rajput EF, Bocking SM, Auer RN, Rajput A. Parkinsonism in essential tremor cases: A clinicopathological study. Mov Disord. 2019 Jun 10. https://www.ncbi.nlm.nih.gov/pubmed/31180613iiTarakad A, Jankovic J. Essential tremor and Parkinsons disease: exploring the relationship. Tremor Other Hyperkinet Mov. 2018 8:589.iiiIbid.
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How Is Essential Tremor Diagnosed
The appearance of your tremor, in the setting of a comprehensive neurological examination by an experienced clinician, can result in diagnosis of essential tremor. Your doctor will probably need to rule out other conditions that could cause shaking or trembling. For example, tremors could be symptoms of diseases such as hyperthyroidism. Your health care provider might test you for those as well.
In some cases, the tremors might be related to other factors. To find out for certain, your health care provider may have you try to:
- Abstain from heavy alcohol use trembling is a common symptom among people with alcohol use disorder.
- Avoid caffeine.
- Avoid or reduce certain medicines.
Who Gets Essential Tremor
As many as 10 million people in the United States have essential tremor, according to the U.S. National Library of Medicine. An exact number is unknown because many cases are undiagnosed or misdiagnosed.
- Age: Essential tremor can occur at any age but is more common in adults over 40.
- Family history: Essential tremor can be inherited, though patterns vary. Specific genes have not been confirmed.
- Gender: It affects the genders equally in adults. In childhood, it may be more common in boys.
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Symptoms Of Essential Tremor
Essential tremor symptoms begin gradually and are usually more prominent on one side of the body. Often, ET patients notice that the shaking will worsen with movement.
The tremors usually begin in a patients hands, affecting one or both hands, then spread to other parts of the body. Parts of the body affected by essential tremor include the legs, arms, head, and voice.
Essential tremor causes involuntary movements in the larynx , throat, tongue, and vocal folds. These involuntary movements cause an essential tremor patients voice to tremble, fluctuate in volume, or otherwise be hindered in terms of vocal sound production.
How Does Essential Tremor Affect My Body
Essential tremor causes parts of your body to shake when you try to use them. This is usually a problem when using your hands but can also affect your head, voice and other body parts. Essential tremor is a condition that gets worse slowly, taking years to reach levels where it starts to disrupt a persons life.
In the earlier stages, essential tremor isnt a problem. Some people may find it makes certain activities harder, but many can compensate. However, as the condition worsens, it can cause problems with fine-detail work and activities, such as handwriting, using eating utensils, sewing or tasks requiring precision.
As essential tremor worsens, this condition can have more severe effects. People who have it may not be able to feed themselves or even cook because of how severely their hands shake. Others may not be able to write, dress, bathe or otherwise take care of themselves.
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Treatments For Parkinsons Disease
While currently available Parkinsons treatments cannot slow or halt the disease, they can help manage symptoms. According to the American Parkinson Disease Association, here are some of the most common treatment options:
There are also lifestyle changes that you can make to help with your Parkinsons symptoms, including:
- Practicing strength training to help with movement
- Stretching to help with rigidity
- Getting massages to relieve muscle stiffness and stress
- Eating a healthier diet to help with lethargy
While these are the most commonly recommended treatment options for Parkinsons disease right now, there is a lot of effort and financial support toward finding new solutions, including clinical trials of medications.
When Does The Shaking Occur
The most significant difference between essential tremor and Parkinsons disease has to do with when a persons tremorous movements occur. In someone with essential tremor, their shaking occurs when part of their body is active. In someone with Parkinsons disease, their tremor occurs in parts of their body when those parts were otherwise at rest.
Imagine watching someone with a tremor while they are relaxing on the porch. In a person diagnosed with essential tremor, you may not know they have a tremor until they try to move the affected body part. For example, when they reach for their glass on the table, their hand may shake.
In a person with a tremor from Parkinsons disease, you will see the tremor while they are at rest. Their hand may shake while it is on their lap or resting on the arm of their chair. When they reach for their glass, though, the tremor will stop until their hand is at rest again.
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What Causes Essential Tremor
The cause of essential tremor is unknown. However, one theory suggests that your cerebellum and other parts of your brain are not communicating correctly. The cerebellum controls muscle coordination.
In most people, the condition seems to be passed down from a parent to a child. If your parent has ET, there is a 50% chance you or your children will inherit the gene responsible for the condition. Sometimes, ancillary testing such as brain imaging or genetic testing may help with the diagnosis.
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Who Is Affected By Essential Tremor
Up to 10 million Americans are estimated to have essential tremor 10 times the number of people with Parkinsons disease. ET affects males and females equally across a multiracial population. Individuals with a clear family history of tremor are at greater likelihood of developing ET. However, it can occur in individuals without a clear family history. While it can start at any age, onset is most common in middle age.
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Association Between Et And Pd
Although ET and PD appear to be two distinct diseases, there is increasing evidence suggesting an association between ET and PD. The association between the two movement disorders includes a similar tremor frequency range of 48 Hz in both ET and PD , overlapping resting tremors and postural tremors in some of ET and PD patients, and many ET patients develop PD later in life . Recent casecontrol and genetic epidemiological studies indicate that ET is associated with an increased risk of PD. For example, 5.9 to 7.1% of PD patients had previously been diagnosed with ET at least 35 years before the onset of PD . The individuals with family history of postural tremors or ET also showed higher risk of PD . In addition, functional neuroimaging studies also demonstrated association between ET and PD. Studies of dopamine transporter ligands using 125I-beta CIT and 123I-ioflupane have shown dopaminergic deficiency in the striatum of ET patients compared to controls . A reduction of dopamine uptake was also reported in the putman of ET patients . Moreover, studies also found PD neuropathological marker, Lewy bodies, in the locus coeruleus of some ET patients . However, the specific pathophysiology of the tremors in both diseases requires further investigation.
What Is Essential Tremor
Essential tremor is a neurological disorder that causes involuntary, rhythmic shaking. While it can affect any part of the body, essential tremor often occurs within the hands. People with essential tremor have difficulty performing many simple tasks, like eating cereal, tying their shoes, or drinking from a glass.
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Can I Treat Essential Tremor At Home
Essential tremor impacts every patient differently. You may find that your essential tremor does not impact your life enough to seek treatment. You may also find that lifestyle modifications may provide relief for your tremors.
Whether you are working with your physician, a neurologist, or are treating your essential tremor at home, the following may help improve your symptoms:
- Adopting relaxation techniques like deep-breathing exercises, yoga, or biofeedback
- Avoiding stressful situations and/or caffeine
- Integrating essential tremor treatment exercises and other physical activity like resistance training, balance activities, and stretching activities under the guidance of a healthcare provider
- Changing or stopping medication only after consulting with your physician
- Following a set sleep schedule
- Using products that make everyday tasks easier, like:
- Clothes with Velcro fasteners
- Kitchen utensils with larger handles
- Drinking straws
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How Does Presence Of Essential Tremor Affect Progression Of Parkinson Disease
Among patients with Parkinson disease, a positive history of essential tremor was found to be associated with slower progression of motor and nonmotor symptoms, with no impact observed on survival.
Among patients with Parkinson disease , a positive history of essential tremor was found to be associated with slower progression of motor and nonmotor symptoms, with no impact observed on survival, according to study findings published in Scientific Reports.
In recent years, the relationship between ET and PD has become a controversial debate. In the past, they were regarded as 2 different conditions that represent the most common tremor disorders in adults, explained the study authors. However, subsequent studies indicated that the presence of ET significantly increased the risk of conversion to PD.
In light of these emerging studies, some scholars have sought to classify the coexistence of both conditions as Essential tremor-Parkinson disease syndrome, which is characterized by patients with a long-lasting history of ET that then developed into PD. For those with ET-PD syndrome, research has indicated that patients are older at onset of PD diagnosis, exhibit less severe PD, and are on a lower dosage of levodopa compared with patients with PD without preexisting ET.
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Next Steps: Getting Care For Parkinsons And Essential Tremor
If you believe you have Parkinsons disease or essential tremor, dont hesitate to seek professional care. Your doctor can help you diagnose your condition, find the right treatment plan for you, and manage your symptoms so you can enjoy the best quality of life possible. While suffering from a condition like essential tremor or Parkinsons can be frightening, you dont have to face it on your own.
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Symptoms Of Parkinsons Disease And Essential Tremor
The differences between Parkinsons and an essential tremor include:
- Tremors are mostly seen when the body is at rest in Parkinsons disease.
- Tremors occur at a higher frequency and when trying to reach things in essential tremor.
- Both start on one side of the body, commonly in the hands. Some Parkinson plus syndrome starts on both hands.
- Essential tremors can be seen in other family members 50% of the time.
- Tremors in head and voice are more common in essential tremor.
- Other symptoms can be seen in Parkinsons patients including stiffness, balance issues, gait issues, and slowed movements.
- Parkinsons patients often experience a change in handwriting which makes the letters very small, while essential tremor handwriting gets large and quivery.
There are also other causes for tremors, such as: medication induced tremors, vascular tremors, and metabolic associated tremors. The diagnosis is made based on a complete medical history and physical exam, sometimes with the help of lab and imaging tests, by a neurologist. It is important to write down the symptoms you are having and be as specific as possible so you can share the details with your doctor.
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Are There Surgical Options For Essential Tremor
Deep brain stimulation is a therapeutic option for those with severe disabling ET not already managed by medications. DBS is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. It is primarily utilized for patients who have Parkinsons disease, dystonia, or essential tremor, who cant adequately control their disease with medication.
Thalamotomy, involving the destruction of tremor producing cells in the brain region called the thalamus, is another surgical option. Using a small temperature-controlled electrode, a permanent lesion is created in the thalamus that helps to stop tremor without disrupting sensory or motor control.
Talk to your doctor about surgical and non-surgical options that are right for you.
What Makes A Parkinsons Tremor Different
The tremor that occurs in Parkinsons disease is different from almost all other tremors because it is a resting tremor since it presents primarily at rest. It goes away with movement, but often returns when the limb, usually a hand or fingers, are held in one position. While holding a spoon or fork to the mouth, the tremor can reappear which is why those with Parkinsons are known to spill things. Parkinsons disease tremor may affect almost any part of the body, but most commonly involves the fingers, followed next most commonly by the hands, jaw, and feet.
Does Essential Tremor Get Worse Over Time
Typically, ET symptoms gradually worsen over time. While most people with ET only experience mild to moderate symptoms as they age, others may experience substantial disability. As it progresses, tremor frequency may decrease however, tremor amplitude may increase, which can cause challenges with fine, discrete motor skills such as writing or eating. With treatment, symptoms can be managed.
The Relationship Between Essential Tremor And Parkinson’s Disease
Essential tremor and Parkinson’s disease have overlapping motor features.
Evidence suggests an increased prevalence of Parkinson’s disease in essential tremor patients.
There may be overlap in dopamine transporter imaging abnormalities in essential tremor and Parkinson’s disease.
Genetic studies have identified shared genetic mutations in essential tremor and Parkinson’s disease.
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