Essential tremor: New advances

Abstract

Background Essential Tremor (ET) is one of the most common movement disorders but many controversies still exist in regards to its definition and pathophysiology. In view of the recent published criteria by the Tremor Task Force of the International Parkinson's and Movement Disorders Society (IPMDS), we intended to analyze if this has changed our view of ET and if new developments have arisen since. Methods A Medline search for English-written articles was done on June 15, 2019 using the keyword “Essential Tremor”. Publications from November 2017 (publication date of the new tremor classification) were taken into account. Reviews, letters and original studies relevant to the subject were selected and reviewed according to the following themes: clinical characteristics, epidemiology, genetics, pathology, biomarkers and treatment. Results Out of 132 publications the most relevant articles were selected and reviewed (total of 65 articles). The great majority of these studies focused on surgical treatments (new targets, new technologies) while relatively few articles addressed epidemiology, pathology and pathophysiology. Conclusions The use of the new classification is not commonly used still, excepting more recent studies on therapeutics. This is in keeping with diverse opinions and criticisms reported by the IPMDS task force members themselves. One important change has been validating ET as a heterogeneous condition and defining the ET-plus category. We propose a further sub-group classification derived from the new definition of ET-plus.

Closing the Loop With Cortical Sensing: The Development of Adaptive Deep Brain Stimulation for Essential Tremor Using the Activa PC+S

“…Future studies of aDBS with larger numbers of patients will also be capable of investigating the variations observed between patients. Recent work is increasingly suggesting that ET is not a single disorder, but rather a family of related disorders that need to be treated slightly differently (Soto and Fasano, 2020 ). This is also supported by the wide variation in effective stimulation settings observed even in our relatively small cohort of patients.…”

“…Classically, the strongest tremor is apparent in the extremities, especially the hands, but will often also be accompanied by trunk tremor (Haubenberger and Hallett, 2018 ). Despite its prevalence, the non-lethal nature of the disorder means that it has been understudied for many years and the pathophysiology is still poorly understood (Soto and Fasano, 2020 ). Once patients are diagnosed, initial treatment is usually pharmacological, but for severe, pharmacologically refractive cases DBS is a promising option (Lyons and Pahwa, 2004 ).…”

Medications used to treat tremors

“…The predominant treatment option for tremor control, however, is the use of medication. More than half of patients with Parkinsonian tremor or ET achieve satisfactory control of tremor with available drugs and it is recommended to try at least two first line drugs before referring patients with ET for a surgical procedure [4]. The earliest experiences for relief of ET for some patients is discovery that ethanol is beneficial.…”

Brain Donation Decisions as Disease Specific Behaviors: An Elucidation of the Donation Process in the Context of Essential Tremor

“…An additional reason for PCPs to have limited access to up-to-date information involves the rapid pace of new findings in clinical description, neuropathology findings and potential treatment of ET [ 48 49 ]. All of the above-mentioned factors, together, compromise the knowledge of treating physicians and the information or lack thereof they share with patients, resulting in frequent misdiagnosis [ 50 ].…”