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Suggest treatment for essential tremors

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
User rating for this question
Very Good
Answered by

Neurologist
Practicing since : 1994
Answered : 5616 Questions
Question
Sir,

I am XXXX (Age: 27 yrs.)_belongs to XXXXXXX presently working in Oman. I do computer

related works throughout the day.

History & Present condition:

When I was 11 years old, I felt tremor in my hand while writing or threading a needle. Gradually, the

tremor started increasing and the situation was worse during my college days (age 16 to 20). While I

was 22 yrs. old the tremor started spreading to my arm, hand and sometimes I feel it on head and other

body parts during movements such as eating and writing. Now-a-days my fingers on both hands also

started shivering making it difficult for me to work on computer. I feel body weakness also. The situation

get worsen when I feel nervous.

The doctor named my problem as “Essential Tremor”.

Medication taken:

Unfortunately, doctors were not consulted earlier due to ignorance.

For the first time on 08-08-2013 (Age 26 yrs.) I consulted a neurologist (Dr. XXXXXXX XXXXXXX XXXXXXX Deccan

hospital, Hyderabad), since I was working there.

He suggested for CT & MRI Scan and thyroid test and all the reports were normal. He prescribed_

Betacap 40mg,

Lonazep 0.5mg

Rejunex.

These medicines were consumed for 3 months but couldn’t find any relief.

Then another 3 months following medicines were consumed and it didn’t make any relief.

Nurokind plus &

Ecosprin 150mg

After this another doctor in my home town, XXXXXXX suggested to take_

Gabapentin 100mg,

Ecosprin 150mg &

Wysolin 10mg.

This was consumed for one and half months. I felt quite relax in my head and body but there was no

effect on hand and fingers. So I stopped taking it.

Now the situation is same as before.

Recently I consulted a doctor nearby my work place, Oman.

He suggested for a blood test (CERULOPLASMIN). Result was normal. He prescribed_

Primidone 50mg. (Since the medicine is not available in Oman, I have not consumed it. I am trying to get

it from India).
Tue, 5 Aug 2014 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 18 minutes later
Brief Answer:
Diagnosis is essential tremors.

Detailed Answer:
Hi Mr XXXXXXX

Thank you for posting your query.

I have noted your symptoms, and the fact that all your reports are within normal limits.

This confirms that you have a condition called as essential tremors (also called as familial or benign tremors).

The initial treatment for such of my patients consists of medications initially. The medicines effective for treating this condition include:

1. Propranolol- the dose can range from 40 mg once daily to 80 mg once daily depending on the response.

2. Topiramate- a dose of 25 mg to 100 mg once daily can be sued.

3. Primidone (brand name- Mysoline)...not easily available now a days.

The next approach in some people who do not respond to medications is surgery. This surgery is called as deep brain stimulation surgery, where a stimulator is implanted in the brain by a surgery.

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.
     
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 16 minutes later
I have tried some of these medicines earlier. I don't think these medicines will be helpful to me. Without surgery is there any other possibility to cure?
 
 
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer:
Botox may be tried.

Detailed Answer:
Thank you for getting back.

If medicines fail in your case, you may consider botox (botulinum toxin) injection. The injection is given in the affected muscles of forearms, and it needs to be repeated at three month intervals.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 13 hours later
Ok, Shall I first try Topiramate or primidone?
which one is much effective for treatment?
If Topiramate, should I use 50mg does daily after food?
If primidone, Please tell me the does and the uses.
 
 
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer:
Topiramate

Detailed Answer:
Thank you for getting back.

Please use topiramate for its better efficacy and safety profile compared to primidone.

If you were my patient, I would start topiramate at a dose of 25 mg once daily and increase to 50 mg once daily after that. I would like to know about you after one month of using this medicine.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 59 minutes later
Dear sir,

Ok, I will go for topiramate.

Could you tell how safe is botox (botulinum toxin) injection and how long have to take? Will I be felt cure after taking injection?
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Botox is safe.

Detailed Answer:
Thank you for getting back.

Botox injections are safe, and the effect lasts for three months. The injection should be repeated every three months.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 17 hours later
Dear sir,

I have heard about Ultrasound Treatment for Essential tremor. I saw some videos of patients they have been cured 90 percent. please describe about this and tell me is this treatment available in India?

Thanks
XXXX
 
 
Answered by Dr. Sudhir Kumar 7 hours later
Brief Answer:
It is not available here.

Detailed Answer:
Thank you for getting back.

I am not aware of the ultrasound treatment for essential tremors. Please send me any link for that treatment or attach the videos.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 11 minutes later
Dear Sir,
please watch this video on below link:
http://on.aol.com/video/ultrasound-treatment-to-stop-hand-tremors-0000

You can see the webpage:
http://www.insightec.com/Essential_Tremor.html
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
This treatment is in experimental stage.

Detailed Answer:
Thank you for getting back.

I went through the website links and the video. This treatment is in experimental stage (trial stage) and is not approved for routine use in clinic.

This treatment is equivalent to deep brain stimulation and brain surgery, as it tries to damage the brain tissues responsible for causing tremors.

If you are interested in the experiment, you may get enrolled in one of the USA hospitals doing that trial.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 23 hours later
Dear Sir,
Thanks for the information.

I have started topiramate 25mg & 50mg. I will take it for 1month.
If I feel better, Would I continue with it?
If yes, then how long?

If it doesn't work, Shall I try primidone?
 
 
Answered by Dr. Sudhir Kumar 6 minutes later
Brief Answer:
You can continue topiramate.

Detailed Answer:
Thank you for getting back.

If you feel better, you may continue topiramate for long periods, as it is safe, if used for long. As you know, topiramate would not cure essential tremors, it would only provide symptomatic relief, while you use it.

If topiramate does not work, you may try primidone.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 13 hours later
Dear Sir,

means if I stop taking medicine symptoms will back to initial condition?

I read some articles on essential tremor they written long time XXXXXXX theorphy will make 60% to 70% reduce the tremor.
 
 
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer:
Partial improvement may occur

Detailed Answer:
Thank you for getting back.

I agree that the severity of tremors may become less, however, complete cure usually does not occur with medications in essential tremor cases.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 1 hour later
Dear Sir,

If I go for Botox injections, Would it be made complete cure?
 
 
Answered by Dr. Sudhir Kumar 3 minutes later
Brief Answer:
Botox works for three months

Detailed Answer:
Thank you for getting back.

Botox would not lead to complete cure of essential tremors.

Botox injections have an effect for three months or slightly more. So, the effect of this would last for 3-4 months, and botox injections may need to be repeated after 3-4 months.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 2 hours later
Dear sir,

How much does Botox injection cost?
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Depends on the dose.

Detailed Answer:
Thank you for getting back.

The cost depends on the dose of botox used. For one hand, a dose of 100-150 units may be needed. So, for both hands, 200-300 units may be needed. The cost of 100 units of botox is about Rs 20,000/ (twenty thousand only).

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for essential tremors 45 hours later
Dear sir,

Please answer these Queries:

1) Is Essential tremor curable?
2) Can long term medication make it cures?
3) If medication being stopped will it return back to initial condition?
4) How effective is deep brain stimulation and how much does it cost?

thanks,
XXXX
 
 
Answered by Dr. Sudhir Kumar 22 minutes later
Brief Answer:
Replies are below:

Detailed Answer:
Thank you for getting back, my replies are below.

1. Essential tremor is not curable.
2. Long term medication may reduce the severity but can not cure essential tremors.
3. If medications are stopped, symptoms would come back.
4. DBS is done in severe cases of essential tremors and it is effective in them. The cost in XXXXXXX varies from 6-10 lakhs.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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