'treatment' Neuroscience (SNI) posts

Tremor is a normal physiologic reaction to anxiety or stress, but it is not normal to have a tremor when performing typical daily activities.

People who develop a tremor while eating, drinking, writing or doing other common activities may have a movement disorder called Essential Tremor. This is actually the most common movement disorder, and can affect up to 4% of people over age 40. People who have this disorder can take medications to help minimize the tremor, but they don't often reduce the tremor by more than about half. Deep brain stimulation (DBS) is an excellent treatment option for people with severe tremor, and can nearly eliminate the tremor in many patients. Many patients aren't sure when their tremor is severe enough to warrant surgery, and much of our conversation in the office is to help answer this question.

There is no one answer that is right for everyone, but for me it has to do with how well someone is actually doing in their daily life:

 On September 12, 2012, the Food and Drug Administration (FDA) approved teriflunomide for the treatment of multiple sclerosis (MS). Teriflunomide (AUBAGIO) is a once-daily pill for the treatment of relapsing forms of MS. Led by Dr. Lily Jung Henson, the Swedish Neuroscience Institute was among several clinical sites that tested the drug. Results of the research showed that teriflunomide can lessen MS disease activity. Specifically, it behaves similarly to injectable therapies by slowing MS relapse frequency, the rate of disability and MRI activity.

The safety profile, however, is more challenging than ....

Essential tremor (ET) is the most common type of movement disorder, affecting approximate­ly four out of 1000 people, and is significantly more common, though less recognized, than Parkinson’s disease. ET affects men and women equally and is inherited as an autosomal-dominant condition in about 60 percent of cases.

Although often referred to as benign essen­tial tremor, it is hardly benign in patients who may not be able to write legibly, hold a glass of water or use a knife and fork. ET is primarily an action tremor of the upper extremities but may involve resting tremor of the head and neck and/or lower jaw, and also tremor of the voice. The latter may be so severe that speech becomes unintelligible.

Medication and surgical treatment options

Primidone and beta blockers are useful in re­ducing tremor in the early stages of ET, but as the tremor progresses, medical management often becomes less effective or side effects can prevent the use of adequate doses of medication. ET pa­tients then are candidates for surgical or radiosur­gical treatment.

The mainstay of the surgical treatment of ET is deep brain stimulation (DBS), in which an electrode is implanted in the ventral inter­mediate nucleus (VIM) of the thalamus. Neurosurgeons Peter Nora, M.D., and Ryder Gwinn, M.D., have been implant­ing DBS electrodes at Swedish Medical Center for several years. The treatment is effective, but it requires implantation of permanent hardware (wires and batteries) into the brain and chest wall. Patients who take anticoagulants or have severe cardio­vascular disease are not suitable candidates for DBS. These patients, however, may be candidates for radiosurgical treatment.

A new option for difficult-to-treat patients