Anyone who takes drugs to control essential tremor (ET) is not doing so for recreational purposes. Life with ET ranges from annoying to desperate. When a person is diagnosed with ET, the first line of defense is almost always prescription medication. Knowing that drugs may help offers a ray of hope. And, for about 50% of persons, the hope is fulfilled. After all, if life can improve by popping a pill or two, that’s a good thing. For many, it may become a long-term solution.
As long as medication is effective, life is good – certainly better than living with tremors. However, depending on drugs for quality of life is a two edged sword. On the upside, managing the tasks of life and avoiding embarrassment or negative assumptions makes getting through the day more pleasant. On the downside, using drugs often brings problems.
Problems with drugs
The two most commonly prescribed medications for ET are propranolol and primidone. A doctor may prescribe one or the other to start, or sometimes they are prescribed together to improve success.
A low dose is prescribed to begin with. Then based on feedback from the patient, the doctor can adjust the dose. In the best case scenario the medication succeeds and there are few to no side effects. However, that may be a delicate balance. If tremor progresses over time, it may happen that success diminishes while side effects increase. The trade-off between side effects and effectiveness can be a painful dilemma. “I can drink my tea without spilling it but I hate how foggy I feel,” is a typical complaint.
If the two major drugs are not working out, the doctor may next turn to other classes of drugs, leading to what I call drug roulette. The list of choices sounds like a chemistry textbook: calcium channel blockers like sotalol and atenolol; benzodiazepines like alprazolam; and anti-seizure drugs such as gabapentin and topiramate. Since every case of ET is unique to that individual, trying new drugs can become a hit-or-miss proposition. Several partially empty pill bottles can make the inside of a medicine cabinet look like a drugstore stockroom.
Another problem with taking drugs is mindset. Many people simply don’t like the idea of taking drugs. They don’t like the idea of putting something unnatural in their bodies. There are also people who feel that taking drugs is a way of admitting defeat, as if they couldn’t manage the problem without a crutch. Or, they believe that taking medication somehow confirms that they have an embarrassing or shameful problem. Thus, people who have strong negative associations with taking drugs may be missing out on a potential solution for improving quality of life even though results may eventually fade away.
To sum up, about half of people with ET find that medications make their lives better. For the other half, either the drugs don’t work, or they work but with but they come with a price tag, or they just don’t want drugs. What does the medical world have to offer those 50% of individuals who have a strong wish for a drug-free solution?
A noninvasive drug-free solution
Today, we do not yet know exactly what causes tremors to begin. We also do not have a cure for ET. The best science has to offer is increasing evidence that abnormal brain signals originate in the cerebellum and travel along a very specific pathway in the brain until they reach the part of the body that is tremoring.
Therefore, an elegant ET solution is to interrupt the pathway in the brain so that the abnormal messages never reach the outer body part. Since ET most often affects the hands, studies of brain anatomy have identified a very small nucleus in the center of the brain that acts like a switching station for tremor signals to the hands. If this switching station, called the VIM nucleus of the thalamus, can be shut down without harming other movement function, it blocks the tremor signals from reaching the hand.
We now have a safe, effective and noninvasive way to shut down the VIM nucleus. It is called Focused Ultrasound (FUS). It is an outpatient procedure done under real-time MRI guidance. By directing over 1000 beams of ultrasound through the skull into the VIM nucleus on the side of the brain that controls the dominant hand, enough heat is generated at that precise spot to shut down the activity of the VIM nucleus. The result is immediately gratifying. In fact, when tremors stop, joy awakens. Improved quality of life begins then and there, and medications become a thing of the past.
FDA approved to treat ET
At Sperling Neurosurgery Associates, we offer Neuravive, the FDA-approved FUS treatment that does not involve drugs, surgery or radiation. It is safe and durable, and most importantly it allows our patients to “just say no” to ET drugs.
Visit our website for more information on the treatment, and how to contact us.