Idiopathic tremor, also known as familial or benign idiopathic tremor, is an autosomal dominant hereditary disease. It is the most common extrapyramidal disease and the most common tremor disease. About 60% of patients have a family history.Postural tremor is the only clinical manifestation of this disease.The tremor of this disease is commonly seen in the hands, followed by head tremor, and few patients have lower limb tremor.Tremor worsens when people are concentrated, nervous, tired, or hungry. Most cases temporarily disappear after drinking and worsen the next day.
Foreign name
essentialtremor
Visiting department
Neurology
Common diseases
Hand, head
Common causes
Genetic factor
common symptom
Postural tremor
infectivity
nothing
Science popularization in China
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The certification expert of this term is
Li Aimin|Chief physician
Air Force Hangzhou Aviation Medical Identification Training Centercompose
Zhang Rongjian|Chief physician
Air Force Hangzhou Aviation Medical Identification Training Centercompose
Wang Zhengyang|Deputy chief physician
Air Force Lintong Aviation Medical Identification Training Centercompose
More than 1/3 of the patients have a family history with autosomal dominant inheritance. At present, two pathogenic gene loci have been identified, located in 3q13 (FET1) and 2p22-25 (ETM or ET2).
clinical manifestation
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This disease occurs more than ten years old or in early adulthood. Tremor is the only clinical symptom, which is characterized by postural or behavioral tremor, often involving one hand or both hands or the head. The symptom gradually becomes obvious until later.In addition to appearance and social embarrassment, it usually does not cause disability. In some cases, tremor can prevent the hand from completing fine movements such as writing. When the laryngeal muscles are involved, it can affect the pronunciation. Most of the lower limbs are not involved.Patients often report that a small amount of alcohol can significantly alleviate the symptoms, but it is short and the mechanism is unclear.Examination usually shows no other signs of nervous system.
treatment
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1. Drug treatment
(1) Beta blockerPropranolol needs to be taken irregularly;Almar has better effect and less side effects, and is more commonly used in clinic. Before taking medicine, ECG should be checked to exclude slow rhythm and conduction block.
(2) PupilonePupilone is also effective, but patients with idiopathic tremor are often very sensitive to this drug. It should not be used to treat epilepsy, but should start from a small dose.
(3) AlprazolamOccasionally, alprazolam is effective for patients.
2. Other treatments
A few patients with severe symptoms, mainly unilateral and ineffective drug treatment can be treated with stereotactic thalamic lesion. Deep thalamic stimulation (DBS) is an effective alternative therapy.DBS technology has its outstanding advantages over previous surgical methods.First, DBS is reversible and adjustable.The operation does not damage the nerve nucleus, but only makes it temporarily paralyzed to improve the nerve function. The degree and range of nerve nucleus paralysis can be adjusted by setting multiple factors such as current, voltage, frequency and electrode position of deep brain electrodes.In the long days after the operation, it can also be constantly adjusted with the change of the condition, and can control the developing and changing idiopathic tremor symptoms for a long time.Secondly, DBS is experiential.After electrode implantation in surgery, the patient can be adjusted, experienced and observed personally by temporary stimulation, and then the final and optimal electrode implantation site can be determined.Thirdly, DBS is developable.The operation preserves the nerve function of normal brain tissue, creates conditions for possible new methods in the future, and also reserves the right and hope of patients to obtain new life.Finally, DBS is bilateral.The symptoms of patients with bilateral idiopathic tremor can be effectively controlled. Damage to bilateral pallidum or thalamus is prone to serious complications.In addition, DBS rarely has side effects, which is an important reason why patients are willing to accept.
