About Essential Tremor

Essential Tremor - A neurological condition impacting everyday Filipinos

Essential Tremor (ET) is a neurological condition that causes uncontrollable shaking of the hands, head and voice, and sometimes arms, legs and trunk. In the initial stages, the tremor is mild, and it progresses over time. In some patients, the severity of the tremor becomes unbearable, interfering significantly with daily activities, such as eating, dressing and writing and limiting independence.

As the disease progresses, eventually some patients will be unable to feed themselves using normal eating utensils or drink from a cup. Quality of life is a key issue as daily activities such as eating, drinking, grooming and writing become difficult if not impossible.

Essential tremor is more common in people age 40 and older, but there are many people afflicted at an early age, with diagnoses of patients in their twenties and even in adolescence.

Many people with essential tremor may be embarrassed to go out in public and remain isolated in their homes, which may affect mental health.

Medication

Sample Symptoms of Essential Tremor can sometimes be suppressed by medication. Common medications include:

Propranolol: primarily used for treating high blood pressure
Primidone: an anti-seizure medicine
Anti-anxiety medications can be useful in some patients

Surgery

If Essential Tremor is debilitating and does not respond to medication, brain surgery may be an option. Two types of surgery are common: Deep Brain Stimulation (DBS) or Surgical Thalamotomy. Surgical Thalamotomy and Deep Brain Stimulation both require surgically opening a flap of skin, drilling through the skull bone, piercing the dura and pushing probes towards the intended target deep within the brain. Highly skilled surgeons exercise great caution to avoid damaging healthy brain tissue during this procedure.

Surgical Thalamotomy:

Thalamotomy is a surgical procedure targeting the thalamus. Neurosurgeons target deep into the middle of the brain to destroy a precise location in the thalamus and interrupt the motor circuit in the brain. Different methods can be used to kill the brain cells, including radio-frequency and radiation.

Deep Brain Stimulation (DBS):

For DBS, electrodes are implanted at the target area of the brain responsible for the tremor. These electrodes are connected via wires down the patient’s neck, to an electronic generator implanted in the chest. When the generator is turned on, it creates a field that interrupts the circuit. The doctor has some freedom to optimise the field after implant without re-operation. However, on occasion the probe must be repositioned to get closer to the target, by pushing it through healthy brain tissue to the new desired location. The field can be switched off and the DBS probe can be taken out if needed, requiring another operation.

Risks and side effects of Surgery

Healthy brain tissue is damaged due to insertion of the probe, e.g haemorrhage.
If a probe is placed incorrectly, it can have neurological side effects, such as numbness or balance issues.
The probe may need to be repositioned in the brain if the insertion is too far from the target, damaging further tissue.
Surgical risks are associated with drilling through the skull bone, incisions etc.
Neurosurgery of this nature has a 0.5% risk of stroke, which can result in weakness on one side of the body, speech difficulties or vision damage.
Any physical surgical intervention carries a risk of infection, which can have severe consequences.
Damage caused by probe pathway to surrounding tissue.
Whilst the placement of probes used for DBS can be reversed by surgical removal, this does not reverse damage caused by incisions, drilling and penetrating the brain or other aspects of the operation.
Intracranial haemorrhage may also occur during the operation, related to the device implant, or procedure performed.
Balance and speech may deteriorate post-surgery on activation of the implant electrode [DBS].
Other non-severe risks include numbness, tingling, weakened strength on one side of the body, marginal paralysis or heightened tremor.

Exablate Neuro Therapy

Exablate Neuro therapy is incisionless brain surgery for reducing tremor in Essential Tremor patients. Using focused ultrasound waves, guided by MR, the physician ablates the target tissue in the brain which is responsible for the tremor. The immediate result is a significant reduction in the level of tremor. This typically allows patients to return to normal activity within days.(2)

More than 4000 patients have been treated with this technology at more than 50 treatment centres worldwide.

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