Essential tremor (ET), the most common movement disorder, starts in the brain. Although no one knows exactly how or why dysregulation of motion signals begins, it is increasingly clear that its root lies in the brain’s cerebellum that regulates movement and motor control. Elan Louis, an ET expert at the Yale University School of Medicine, writes, “Numerous neuroimaging studies indicate the presence of functional, metabolic, and structural abnormalities in the cerebellum of a patient with ET.”i
Does “abnormal” mean “unhealthy”?
What does it mean when tremor messages traveling along the brain’s motor pathways are abnormal? Does it imply that the brain is in some way sick or unhealthy? Not necessarily. After all, ET is called a disorder rather than a disease. However, much current ET research is centered on a possibly progressive condition in which special cerebellar nerve cells called Purkinje cells start to degenerate. Since Purkinje cells produce an important molecule called GABA that calms down hyperactive brain transmissions, if GABA levels drop off, it’s like removing the brakes from movement signals. There is, indeed, evidence that ET is connected with the dying off of Purkinje cells.
Reversing the logic suggests that if an unhealthy process—the damage and death of Purkinje cells—results in ET, it raises the question if restoring normal brain function would halt ET. Is that possible? If so, how could it be done?
Nutritional supplements for ET: fact or fiction?
It would be wonderful if all breakdowns in normal physical function could be corrected by all-natural means. We know that healthy diet and nutrition, regular exercise, normal weight, and stress management can preserve health and even prevent illness. Many people with ET find that reducing anxiety and tension through meditation and mindfulness practices help control their tremors, but no lifestyle change has been shown to eliminate them altogether. Thus, when it comes to reversing ET, there is no evidence that a healthier lifestyle can “cure” tremors
The desire for greater wellness through vitamins, herbal products, supplements, nutraceuticals, etc. has spawned an entire industry of capsules, tablets and tonics for virtually every physical, mental and emotional condition imaginable. This includes brain health, usually in the form of better cognitive function and memory. There are even “all-natural” tremor relief products available—just do a Google search or check out Amazon.com and other mail-order sites to see how many are out there. Ingredients vary, but here are some of the substances you might find product formulations include B vitamins (B2, B12, folic acid,), methylcobalamin, passion flower, valerian extract, magnesium citrate, L-tyrosine, taurine, Aceytl-L-carnitine, N-acetyl cysteine, curcumin extract and many more. Some contain GABA (gamma-aminobutyric), the molecule I mentioned above. While there have been some small studies showing that GABA can temporarily reduce anxiety or bring a feeling of calm during stress, no one knows whether taking GABA by mouth produces the same brain effect as Purkinje cells manufacturing it in a form that receptor cells can take it up. Certainly, there’s nothing to indicate that taking GABA in a supplement actually addresses the underlying source of ET.
Undoubtedly, many people with ET who have tried such remedies have experienced a degree of effectiveness, at least for a while. I wrote a blog on two published vitamin studies that were conducted under strict conditions and would not easily be possible for someone to duplicate at home, but each of them generated favorable results. These studies are the exception, though, not the rule.
A new report urges caution
Supplements that make claims for brain or neurological health may not be worth what people are spending for them. The Global Council on Brain Health has issued a 25-page report, The Real Deal on Brain Health Supplements: GCBH Recommendations on Vitamins, Minerals and Other Dietary Supplements. Unlike pharmaceutical drugs, vitamins and supplements are not overseen by the U.S. Food and Drug Administration so they don’t need to prove their claims before they hit the marketplace. The report basically debunks the claims made by those who manufacture and market brain health supplements, and its bottom line is a variation on the centuries’ old wisdom, “Let the buyer beware.”
For countless people with ET who are not helped by conventional drugs like primidone or propranolol, I can understand the urge to try non-prescription natural products or supplements, but keep in mind that costs can quickly add up. According to a news report, “‘Supplements for brain health appear to be a huge waste of money for the 25 percent of adults over 50 who take them,’ says AARP Senior Vice President for Policy Sarah Lenz Lock, the GCBH executive director.”ii Therefore, I urge caution and due diligence in the form of research and discussions with your doctor before putting money on the line.
A lasting solution
Sperling Neurosurgery Associates offers Neuravive, an outpatient treatment using MRI-guided Focused Ultrasound (MRgFUS) to destroy a tiny center in the thalamus in order to durably block abnormal signals that cause hand tremors. For more information, or to arrange a consultation, visit our website.
iLouis ED. Essential tremor and the cerebellum. Handb Clin Neurol. 2018:155;245-258
iFifield, Kathleen. “New Report Pans Supplements for Brain Health.” AARP Brain Health and Wellness, June 11, 2019. https://www.aarp.org/health/brain-health/info-2019/report-brain-supplements-ineffective.html