Essential tremor: what are the treatment options?

Essential tremor is a common neurologic problem. It should be differentiated from secondary causes of tremor and Parkinson disease.

Impact of essential tremor

Essential tremor causes motor dysfunction (e.g. a dentist may have to quit his/her job). However, more importantly, the tremor can have a psychological impact on the patient, especially since it usually gets worse in social situations.

Diagnosis

Essential tremor is a clinical diagnosis. A thorough review of the medical history and medication exposures is a good start. Laboratory and imaging tests may be ordered to rule out a secondary cause.

Treatment

The two first-line agents in drug therapy for essential tremor are:

- nonselective beta-blocker propranolol (Inderal)
- antiepileptic primidone (Mysoline)

They can be used alone or in combination.

Severe, resistant, or atypical cases should be referred to a specialist. Botulinum toxin injection and deep brain stimulation are reserved for resistant tremor or for patients who do not tolerate drug therapy.

Dr. Young from Swedish Medical Center discusses some of the new treatments for essential tremor in this video:



References:

Essential tremor: Choosing the right management plan for your patient. CCJM, 2011.

Myelofibrosis, Polycythemia Vera, Essential Thrombocythemia Update 2014 - Mayo Clinic videos

Will Twitter soon be an essential tool for medical practices? asks CWRU

59% answered "yes", according to the Case Western Reserve University (CWRU) poll.

Doctors are using Twitter to connect both with patients and other medical professionals.

Other doctors use Twitter to communicate with patients - generally not to give medical advice - but to guide the public to reputable sources of information, or share breaking medical news. The CDC, for instance, uses Twitter to provide constant updates on H1N1 influenza.

Finally, Twitter offers an opportunity for doctors to ask questions of other medical providers. Given the real-time nature of Twitter, opinions and answers to clinical issues can be obtained immediately.

Some doctors simply do not have enough time to Twitter, or utilize other social media applications like Facebook. And time spent with patients in the social media sphere is not compensated by health insurance.

But Twitter is a valuable way to reach thousands of people at once.

My opinion: I was a Clinical Assistant Professor of Medicine at CWRU until 2008 and I think it is great that the university community shows an active interest in social media services such as Twitter. Using Twitter frequently @DrVes, I follow 77 accounts and have around 3,500 followers. That said, I am yet to ask medical questions on Twitter and generally do not answer clinical queries from patients there.

References:

CWRUmedicine SHARE Twitter Poll

Assistant professor uses Twitter to teach students dental anatomy at Ohio State University - 113 of 200 students signed up, 56% http://goo.gl/jvyq7

Water as an essential nutrient

Water has numerous roles in the human body:

- building material
- solvent
- reaction medium and reactant
- carrier for nutrients and waste products
- thermoregulation
- lubricant and shock absorber

The regulation of water balance is very precise, as a loss of 1% of body water is usually compensated within 24 hours.

Healthy adults regulate water balance with precision, but young infants and elderly people are at greater risk of dehydration.

Dehydration can affect consciousness and can induce speech incoherence, extremity weakness, hypotonia of ocular globes, orthostatic hypotension and tachycardia.

Human water requirements are not based on a minimal intake because it might lead to a water deficit due to numerous factors that modify water needs (climate, physical activity, diet and so on). On an average, a sedentary adult should drink 1.5 l of water per day, as water is the only liquid nutrient that is really essential for body hydration.



From Wikipedia:

"Water" is a song which opened the Eurovision Song Contest in 2007. The singers explained the title: "Our folklore is like water. We've chosen this title "Water", because in Bulgarian folklore there are very slow beautiful songs, which are like a lake. But we also have songs, with very fast rhythm which are like a waterfall. And my wish is this song to be like "Water", a gasp of fresh air, for the human spirit and soul. When we recorded the promo video of this song, they poured lots of rain on us, and I felt purified. I want everyone, who hears this song to feel the same way- liberated. This is a very positive song! I'm sure that people will feel it!"

References:
Water as an essential nutrient: the physiological basis of hydration. E Jéquier1 and F Constant2. European Journal of Clinical Nutrition (2010) 64, 115–123; doi:10.1038/ejcn.2009.111; published online 2 September 2009.