Neurology

Essential Tremor

Sometimes mistaken for Parkinson's disease, essential tremor (ET) is a debilitating neurological condition that causes shaking in the hands, voice, and head. The majority of ET patients have hand tremors, so everyday actions such as eating, drinking, grooming, and writing are often a challenge. The expert movement disorder neurologists at Mount Sinai specialize in diagnosing and treating essential tremor.

We do not know what causes ET, but there is a genetic component. ET tends to affect relatively healthy people, both young and old, with approximately five percent of ET patients first experiencing tremor during childhood. Researchers estimate that four to five percent of people age(s) 40 to 60 have ET, and the incidence rate for people age 60 and older is estimated at six to nine percent. 

Symptoms

Some people living with ET may experience occasional symptoms or have temporary worsening of tremor, while others have more consistent tremor that, in some cases, can lead to social isolation. Patients may experience a poor sense of balance along with the tremor. People with ET are often frustrated or embarrassed by their symptoms, and can sometimes become disabled if tremors worsen.

Diagnosis

To diagnose Essential Tremor, Mount Sinai movement disorder neurologists conduct a neurological examination and evaluate all your symptoms to rule out other potential causes of tremor. 

Treatments

The symptoms of essential tremor may be managed with the use of medications, surgery or ultrasound, if appropriate. 

Medications

Mount Sinai neurologists collaborate with the patient directly to find the precise balance of medication or combination of medications. Time and patience is required to achieve the best outcomes, as the results of medications and their dosages vary from person-to-person.

Medications may include, but are not limited to:

  • Beta blockers
  • Primidone
  • Topiramate
  • Gabapentin
  • Botulinum toxin injections 

Deep Brain Stimulation Surgery

Currently, the gold standard, most effective surgical treatment for ET is deep brain stimulation (DBS). Most patients experience dramatic improvement in their symptoms, with the greatest outcomes for hand and arm tremor, but may also progress in controlling head, voice, and leg tremor. Mount Sinai’s Center for Neuromodulation is recognized for its excellence in performing deep brain stimulation surgery for selected patients with essential tremor.

With DBS, electrical stimulation is delivered to the brain through an electrode implanted deep into the VIM nucleus of the thalamus and can be done on either one (unilateral) or both sides (bilateral) of the brain. The VIM is an important part of the brain network that contributes to tremor, and the electrodes are placed precisely within this structure. Neurosurgeons connect these electrodes through a wire to a neurostimulator, also called a battery pack, which then delivers electrical stimulation to the brain and can control the symptoms of ET. Neurologists continually follow-up with the patient to carefully adjust the electrical parameters of the device to obtain the most successful results and elimination of symptoms. Your Mount Sinai neurologist will determine if DBS is appropriate for you.

MR Guided Focused Ultrasound

MR Guided Focused Ultrasound is a treatment option available for ET patients who have not responded to medication.  There are no incisions, permanent implants, or radiation exposure for focused ultrasound. Rather, it uses focused sound waves that pass through the skin, muscle, fat, and bone, to treat deep in the brain.

The incisionless procedure is performed at the Center for Neuromodulation at Mount Sinai West. Though results may vary, current scientific literature found most patients get between a 50 and 80 percent reduction in tremor that was maintained for up to three years.

To determine if MR Guided Focused Ultrasound treatment is right for you, please make an appointment with the Center for Neuromodulation for a consultation. 

For more information, please reach out to Tiffany Arnold, tiffany.arnold@mountsinai.org or 212-523-8130