Intention Tremor - Management

Management

It is very difficult to treat an intention tremor. The tremor may disappear for a while after a treatment has been administered, and then return after some time. This situation must be addressed with a different type of treatment. First, individuals will be asked if they use any of the drugs known to cause tremors. If so, they are asked to stop taking the medication and then evaluated after some time to determine if the medication was related to the onset of the tremor. If the tremor persists, treatment that follows may include drug therapy, lifestyle changes, and more invasive forms of treatment, such as surgery and thalamic deep brain stimulation.

Intention tremors are notoriously known to be very difficult to treat with pharmacotherapy and drugs. Although there is no established pharmacological treatment for an intention tremor, several drugs have been found to have positive effects on intention tremors and are used as treatment by many health professionals. Isoniazid, buspirone hydrochloride, glutethimide, carbamazepine, clonazepam, buspirone, topiramate, zofran, propranolol and primidone have all seen moderate results in treating intention tremor and can be prescribed treatments. Isoniazid inhibits γ-aminobutyric acid-aminotransferase, which the first step in enzymatic breakdown of GABA, thus increasing GABA, the major inhibitory neurotransmitter in the central nervous system. This causes a reduction in cerebellar ataxias. Another neurotransmitter targeted by drugs that has been found to alleviate intention tremors is serotonin. The agonist buspirone hydrochloride, which decreases serotonin's function in the central nervous system, has been viewed as an effective treatment of intention tremors.

There are also alternative treatments available. Cannabis has offered as an effective treatment for individuals with tremors, but the inclination to find conclusive scientific data on such a treatment has not existed in the medical community. Equally, it is pertinent to remember there has been no research conducted of any kind on the potential benefits of therapeutic Cannabis treatments, not merely a lack of positive research, something that may well be attributed to political or social constraints on the exploration of such a therapy. Also, physical therapy has had great results in reducing tremors, but usually does not cure the tremors. Relaxation techniques, such as meditation, yoga, hypnosis, and biofeedback, are other alternative treatments that have seen some results with tremors. Wearing wrist weights which will weigh down one's hands as they make movements, masking much of the tremor, is a proven home remedy. This is not a true treatment, since wearing the weights does not have any lasting effects when they are not on, however they do help the individual cope with the tremor immediately.

A more radical treatment that is used in individuals who do not respond to drug therapy, physical therapy, or any other treatment listed above, with moderate to severe intention tremors, would be surgical intervention. Deep brain stimulation and surgical lesioning of the thalamic nuclei has been found to be an effective long-term treatment with intention tremors. Deep brain stimulation treats intention tremors but does not help related diseases or disorders such as dyssynergia and dysmetria. Deep brain stimulation involves the implantation of a device called a brain pacemaker, shown in the picture above. This medical device sends electrical impulses to specific parts of the brain, changing brain activity in a controlled manner. In the case of an intention tremor, the thalamic nuclei is the region of the brain targeted for treatment. This form of treatment causes reversible changes and does not cause any permanent lesions. Since it is reversible, deep brain stimulation is considered fairly safe, and reduction in tremor amplitude is almost guaranteed and sometimes it is even resolved. Some individuals with multiple sclerosis have seen sustained benefits in MS progress. Thalamotomy is another surgical treatment where lesions of the thalamus nucleus are created to disrupt the tremor circuit. Thalamotomy has been used to treat many different forms of tremors, including tremors that arise from trauma, multiple sclerosis, stroke, and those whose cause it unknown. This is a very invasive, high-risk treatment with many negative effects, such as multiple sclerosis worsening, cognitive dysfunction, worsening of dysarthria, and dysphagia. Immediate positive effects are seen in individuals treated with a thalamotomy procedure. However, the tremor often comes back after some time, thus it is not a complete treatment. Thalamotomy is currently in clinical trials to determine the validity of the treatment of intention tremors with all its high risks.