Essential tremor in older people.
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 4
Abstract
Essential tremor (ET) is a chronic neurological condition. Its prevalence substantially increases with age. Symptoms of ET become more severe in older patients and lead to marked disability. Clinical features of ET among postural and kinetic tremor, are ataxia, gait disturbances, oculomotor signs and cognitive deficits. Late onset essential tremor is usually more rapidly progressive and multisymptomatic. Recent research found heterogenous and degenerative neuropathological nature of ET. Two neuropathological subtypes were distinguished: 1) subtype with selective loss of Purkinje cells (about ¾ cases), and subtype with the presence of Lewy bodies selectively in locus coeruleus (about ¼ cases). This, together with clinical symptoms and neuroimaging findings often incline researchers to recognize essential tremor as a primary neurodegenerative condition. 60% of ET cases characterize with positive family history. Three loci for familiar ET are known: ETM-1, -2, -3. It is possible, that genes not yet identified take part in pathogenesis of this disease. Pathogenesis of ET can be also influenced by environmental factors. Organochlorine pesticides, lead and mercury salts, beta-carbolines were found to have the tremorogenic effect. Many drugs often used in treatment of cardiovascular diseases are also tremorogenic. The politherapy, frequent in older people can intensify tremor in ET. Propranolol and primidone are useful in alleviating tremor. They both have a lot of side effects, that limit their use in older people. Deep brain stimulation of nucleus ventralis intermedius can be an effective alternative for pharmacotherapy. Hovewer, the use of neurosurgical treatment is considerably limited in older people
Authors and Affiliations
Włodzimierz Kuran, Grzegorz Witkowski
Keywords
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