Idiopathic tremor is also known as familial or benign idiopathic tremor, where postural or motor tremor is the only manifestation. Idiopathic tremor is an autosomal dominant disorder and is the most common extrapyramidal disorder and the most common tremor disorder, with a family history in approximately 60% of patients. Idiopathic tremor is a single-symptom disorder, and postural tremor is the only clinical manifestation of the disease. Postural tremor is a tremor that is triggered when the limb is maintained in a certain position and disappears naturally when the limb is completely relaxed. Tremor in this disease is commonly seen in the hands, followed by tremor in the head, and in very few patients, tremor in the lower extremities. The tremor of this disease is aggravated by concentration, mental tension, fatigue, and hunger. In most cases, it disappears temporarily after drinking alcohol and worsens the next day, which is also a characteristic of idiopathic tremor. It should be treated symptomatically.
Signs and symptoms.
The disease tends to develop in the late teens or early adulthood. Tremor is the only clinical symptom, manifesting as postural or motor tremor, often involving one or both hands or the head, and symptoms do not become progressively more pronounced until later. In some cases, the tremor may prevent the hand from completing fine motor movements such as writing, and may affect articulation when the laryngeal muscles are involved, while the lower extremities are not involved. Patients often report that a small amount of alcohol can provide significant relief of symptoms, but this is brief and the mechanism is unclear. There are usually no other neurological signs on examination.
Disease etiology.
More than 1/3 of patients have a family history with autosomal dominant inheritance, and 2 causative loci have been identified, localized at 3q13 (FET1) and 2p22-25 (ETM or ET2).
Treatment options.
1.Pharmacological treatment
① β-blockers: 心得安 40-120mg in 2 doses, which needs to be taken irregularly, and temporary oral 心得安 40-120mg if tremor is expected to be particularly severe on a specific occasion.
Almare better effect, less side effects, more commonly used in clinical practice, commonly used dose: 10mg twice a day, morning and afternoon; before taking the drug should be performed electrocardiogram, to exclude the contraindications to beta-blockers such as slow rhythm and conduction block.
②Epileptone is also effective, but patients with idiopathic tremor are often very sensitive to this drug and should not be treated as epilepsy; they should start with a small dose of 50 mg/d and increase the daily dosage by 50 mg every 2 weeks until it is effective or until side effects occur; usually the effective dose is 100-150 mg 3 times/d.
③ Occasionally patients with alprazolam effective, the maximum dose of 3mg/d in divided doses.
2. A few patients with severe symptoms, predominantly on one side and ineffective drug therapy are feasible for stereotactic thalamic disruption, and deep thalamic electrical stimulation (DBS) is an effective alternative therapy.
DBS technique has its outstanding advantages over previous surgical methods. First, DBS is reversible and modifiable. The degree and extent of nerve nucleus paralysis can be adjusted by setting the current, voltage, frequency and electrode position of the deep brain electrodes. In the long postoperative period, it can also be adjusted according to the changes of the disease, so that it can control the evolving idiopathic tremor symptoms for a long time. Second, DBS can be experienced. After surgical implantation, the electrodes can be temporarily stimulated to allow the patient to adapt, experience and observe before deciding on the final and optimal electrode implantation site. Once again, DBS is developable. Surgery preserves the neurological function of the normal brain tissue and creates the conditions for possible new approaches in the future, thus preserving the patient’s right to a new life and hope. Finally, DBS is bilateral. The symptoms of patients with bilateral idiopathic tremor can be effectively controlled, while the destruction of bilateral pallidum or thalamus is prone to serious complications. In addition, DBS has few side effects, which is an important reason for patient acceptance. Because of these advantages, few people in developed countries such as the United States, Canada, and Europe have undergone destruction, and more and more patients with idiopathic tremor have been treated with a brain pacemaker.
The battery of a pacemaker system usually lasts 4 to 8 years. If the battery is depleted, the pulse generator needs to be replaced, but the electrodes and leads do not need to be replaced. This can be replaced with a simple surgical procedure.
Medication safety.
1, psychotherapy: first of all, we must face this reality, not be afraid of people know, so that the mood put calm. In addition, life should be regular and avoid excitement and strain, which is good for the course of the disease.
2, drug treatment: the amount of medication according to the patient’s condition, tremor light can take a low amount, or intermittent, serious should be taken continuously. You should also take some vitamin drugs, such as vitamin E and vitamin C, which have a protective and anti-aging effect on the nerves.
3.Surgical treatment: If you are not satisfied with drug treatment, you can consider surgery. Surgical treatment is the same as the treatment of Parkinson’s disease to stop fibrillation. This disease can not be cured, but through active and timely treatment, can control the disease to slow down the course of the disease.
4, dietary conditioning: eat more anti-atherosclerotic food, such as vegetables, fruits, celery, onions, etc. have the effect of lowering blood pressure and anti-lipidemic, eat more grains and cereals, the richer the variety the better for the condition. High-fat, high-calorie, high-sugar foods should be limited, especially fried foods eaten less.
5, life note: moderate drinking after the symptoms can be reduced, but generally only to maintain 2 to 4 hours, after which the symptoms will be aggravated, so drinking alcohol can not treat the disease, but make the symptoms worse, should be strictly limited.
6, strengthen exercise: elderly people with this disease should pay attention to do as much physical exercise as possible during recovery, such as tai chi, gymnastics.