Essential Tremor (ET) is often age-related but can affect people of any age, but new treatments are making huge strides in addressing the condition. Dr Tabish Saifee, a Consultant Neurologist and member of the Queen Square Movement Disorders group, explains more.
• What is the definition of Essential Tremor?
Essential Tremor (ET) is a neurological condition characterised by involuntary, rhythmic shaking of various parts of the body, most typically both hands. It arises due to rhythmic activity in brain circuits. ET usually occurs without other neurological symptoms and is often most pronounced when performing voluntary movements, such as lifting a glass or writing.
• Who does it affect?
Essential Tremor can affect individuals of any age. The risk of developing ET increases with age and it has a genetic component, meaning it can run in families. We sometimes identify a gene, but, in the majority, there is not a single identifiable genetic abnormality. Both men and women are equally likely to be affected. While it can start at any age, including childhood, the incidence is higher and tends to become more noticeable in middle-aged or older adults.
• Is it related to Parkinson’s Disease?
While both Essential Tremor and Parkinson’s Disease involve tremors, they are distinct conditions with different causes and symptoms. Essential Tremor primarily affects movements when engaging in actions (action tremor), whereas Parkinson’s tremors usually occur with the hands at rest. Parkinson’s also includes other symptoms such as stiffness, slow movement, and balance problems, which are not features of Essential Tremor. Despite these differences, misdiagnosis can occur, especially in the early stages. There is also commonly confusion with other similar conditions such as dystonic tremor or task-specific tremors.
• What can be done to control the condition without medical treatment?
Lifestyle adjustments and non-medical interventions can help manage Essential Tremor. Reducing caffeine and avoiding stimulants can decrease tremor severity. Stress management techniques, such as relaxation exercises, may also be beneficial as stress can temporarily exacerbate tremors. Physical therapy does not typically subdue tremor but can improve muscle strength, control, and coordination. Additionally, using weighted utensils and adaptive devices can help manage daily activities.
• What are the most common medical treatments?
The most common medical treatments for Essential Tremor include beta-blockers (e.g., propranolol) and other medications (e.g., primidone or topiramate), which can help reduce tremor severity. In cases where medication is ineffective or causes undesirable side effects, other treatments may be considered, such as botox injections for head or hand tremors. Targeting the abnormal brain circuits with focused ultrasound or deep brain stimulation (DBS) surgery are very effective options for severe cases or in those where other treatments have not worked. Treatment is tailored to the individual’s symptoms and overall health profile.
In 2022, the Queen Square Imaging Centre developed a partnership with the renowned UCL Functional Neurosurgery Unit (the largest and most active functional neurosurgery group in the UK) to establish a new MR Guided Focused Ultrasound service. Through this unique partnership, Queen Square became the only surgical centre in the UK capable of offering patients a choice of the full range of surgical treatment options for tremor. Professor Ludvic Zrinzo, Consultant Neurosurgeon and Clinical lead for the UCL Functional Neurosurgery Unit explains more about this pioneering incisionless treatment.
• What is involved in MRGFUS?
MRGFUS is a fusion of two wonderful technologies. MRI allows doctors to visualise the key areas of the brain and then use the power of focused ultrasound beams to create a tiny lesion with extreme precision. This amazing tool allows neurosurgeons to perform accurate surgical procedures within the brain without making an incision or using a drill. The procedure takes a few hours and is performed under a local anaesthetic, on an outpatient basis, like a visit to the dentist.
• How effective can it be?
MRGFUS can be extremely effective in patients with essential tremor. The Queen Square team has capitalised on decades of experience in functional neurosurgery, imaging, and multidisciplinary work. Their patients have enjoyed a sustained reduction in tremor of around 60% on the treated side with no serious or persistent side effects. The team are now joining international efforts to explore the use of MRGFUS in other conditions such as Parkinson disease.
• What does it cost?
For patients who are funding the cost of their assessment and treatment themselves, the total package will typically come to just over £25,000. Whilst this is a significant investment for most people, it is important to remember that this is a one-off expense that brings significant and durable improvement in quality of life. We aim to assist patients by providing payment plans to spread the cost. Our service is also unique in that it is recognised by several major UK based health insurers.
• What’s the story behind Queen Square Imaging Centre?
For nearly 40 years, the Queen Square Imaging Centre has offered state of the art MRI and CT scanning and continues to be London’s only imaging centre dedicated to specialist neuroimaging. The centre was the first healthcare social enterprise of its kind in the UK and continues to use an innovative not-for-profit model which sees all profits donated back into the NHS.
• Where can I find out more about Queen Square Imaging Centre?
Further information about the Queen Square Imaging Centre, and the specialist diagnostic and treatment services available can be found at www.queensquare.com, or by email at treatment@queensquare.com.
