![]() Tizanidine is an alternative to baclofen. Baclofen can reduce dystonia by acting on GABAB receptors. Clonazepam, which is a long-acting benzodiazepine, may be preferred in comparison to shorter acting drugs such as alprazolam or lorazepam. Cervical dystonia may respond to treatment with benzodiazepines. Other medication options that are helpful include gabapentin and topiramate. Propranolol and primidone are the mainstay of treatment for essential tremor. The treatment of tremor is guided by the underlying cause. Blood tests to rule out hyperthyroidism and, in younger patients, screening tests for Wilson’s disease may also be considered. This scan is targeted towards the dopamine transporter (DaT) in the brain which is deficient in parkinsonism but normal in essential tremor. In patients where there is a question of whether the problem is essential tremor or parkinsonism, a DaTscan may be ordered. An MRI or CT scan of the brain is usually ordered to rule out structural lesions such as stroke, multiple sclerosis or a midbrain tumor. The diagnosis of tremor remains a clinical diagnosis. This position is referred to as a “null point”. It may be possible when examining the individual to find a head position where the tremor almost disappears. Head tremor with cervical dystonia has a directional component and is usually worse when looking in one direction and reduced when looking in the opposite direction. Touching the cheek or chin (a geste antagoniste) is a commonly employed sensory trick. Patients with cervical dystonia may employ sensory tricks to reduce the severity of the tremor. However, unlike essential tremor the head tremor from cervical dystonia may be associated with neck pain due to dystonic spasms. Like ET, cervical dystonia can spread to one or the other arm, in long-standing cases. Other features include an asymmetric elevation of the shoulders, excessive eye blinking or blepharospasm, and spasms of the facial muscles. An enlargement of the neck muscles may be observed in cervical dystonia but is unusual in essential tremor. Sustained abnormal posturing of the head is a hallmark of cervical dystonia. When the muscle spasms and abnormal posture affect the neck it is referred to as cervical dystonia. Dystonia refers to a state of abnormal muscle tone leading to painful muscle spasms and abnormal posturing of a part of the body. A lip or chin tremor may also be seen in patients with Parkinson’s disease.Ĭervical dystonia can be another cause of head tremor. ![]() Muscle rigidity, slowness of movement, change in posture and gait also occur with Parkinson’s disease but are uncommon with essential tremor. This contrasts with hand tremor in Parkinson’s disease that occurs when the hands are at rest. Hand tremor occurs mostly with posture, such as when holding an object away from the body and against gravity. However, about 35 percent of patients have head tremor either by itself or in conjunction with hand tremor. An abnormal response in this circuit, especially within the ION, can lead to tremor.Īpproximately 95 percent of patients with essential tremor present with hand tremor. Proper function prevents any undershoot or overshoot of movements. This circuit is responsible for fine-tuning voluntary movements. ![]() ![]() One such circuit includes three areas deep in the brain called the red nucleus, the inferior olivary nucleus (ION), and the dentate nucleus. Hyperexcitability and rhythmic activity in the circuits of the brain are believed to be the underlying mechanism for tremor. Stroke, head injury, and multiple sclerosis are other causes of tremor but are less likely to cause head tremor. Head tremor may also occur in patients with Parkinson’s disease. Another cause is cervical dystonia, also known as spasmodic torticollis. Essential tremor is by far the most common cause of head tremor. In patients with essential tremor, head tremor can be an isolated symptom or may occur in combination with hand tremor. While tremor in the hands is most common, head tremor can also occur. The term tremor refers to an involuntary shaking of any part of the body. Annual donors to the IETF receive Tremor Talk magazine in the mail three times per year.)ĭirector of the Comprehensive Movement Disorders Program It’s just a sampling of the stories we include in each issue. (This is an article from a past issue of Tremor Talk magazine. ![]()
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