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Thread: Essential or Intention Tremors

  1. #1
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    Essential or Intention Tremors

    I've been checked out from head to toe to rule out other serious conditions, i.e., Parkinsons, thyroid, stroke, tumor, multiple sclerosis, liver or kidney failure, medications. The neurologist thinks the tremors in my hands are Essential or Intention Tremors, that is the tremor only occurs when I am trying to do something like write or feed myself. When my hands are at rest, I don't have the tremors. I've had the tremors for a few years, but only now are they getting to the point where I have to modify my activity to compensate or them, for instance steady my left hand with my right hand when I try to write my signature.

    A drug named propranolol, a beta blocker, has been suggested, but I already suffer orthostatic and postprandial hypotension and this medication lowers blood pressure and slows heart rate (I have a pacemaker).

    Just wondering if anyone else is experiencing this and what you are doing about it. I'm C6/7 complete, 35 years post injury. In the literature, I've read about Neuropathic Tremor or Peripheral Neuropathic Tremor that occurs when nerves that supply the muscles are traumatized by injury or disease. It seems to me that many spinal cord injured may experience these type tremors due to the injury.

  2. #2
    My father has benign essential tremor in his dominant (right) hand. He has had traces of it for many years, with a bit more progression over the past few years. He first noticed it when he would be trying to sign his name carefully, but now it makes writing challenging all the time. He is a para, so it is not related to his injury.

    You have probably learned that these tremors are quite common, and run in families. I have a tiny trace of it, I think...

    It is worse when he is tired, later in the day, sleep deprived, stressed, and when he is sick or has a fever... and may get worse with increasing doses of the stimulant he takes (modafinil) for daytime sleepiness. He has no tremors at rest. There are no other medical causes of tremor that could be contributing.

    It has been a bit more difficult for him this year. He self catheterizes and as you can imagine, the last thing you want when you are inserting your catheter is to see your hand suddenly start shaking. As you know, the harder you try to "control" the tremor, the worse it gets. Pretty soon that catheter is flapping back and forth like a thrashing snake. Yikes...

    He has mentioned it to his docs, but ?? It's benign essential tremor. Yes, you can try medications, but the last thing he needs is another medication/side effect. So he tries to manage it for now, and in the future, we may change one of his blood pressure medicines for a beta blocker instead to see if it helps.

    It was helpful to talk with an occupational therapist who had some decent ideas. So maybe you should try that? Advice is often basic, yet can be specific to the activity where you have most difficulty.

    When the tremor becomes a problem, some things to try .....

    [] Take a break, and relax the hand.

    [] Bring in the other hand to help (you are learning that one). Do it with both hands, letting the non-tremor hand "guide".

    [] Position the arm against a stabilizing surface to help - upper arm against the body, or the lower arm on the leg/table/arm wrest etc..

    [] Slow down what you are doing. If that doesn't work, try speeding up what you are doing.

    [] Try clenching/relaxing the fist of the non-affected side, while you are using the affected side.

    [] Use a wider/heavier/weighted pen. Can buy on amazon.

    [] Don't use a narrow tipped mechanical pencil. Use a regular pencil with a weight added to it (see amazon), not too sharp.

    [] Add a light weight around your wrist (1-2lbs)

    [] Avoid handwriting - use more digital devices.

    [] Do important activities where you need good fine motor control earlier in the day, not later when you are tired.

    [] Decrease medicines that might be exacerbating tremor. Lots of medicines can have tremor as a side effect.

    [] Drink less caffeine.

    [] Drink more alcohol


    With regard to the propranolol... I hear you about the side effects. You should talk about it with your cardiologist. Honestly, it isn't not the strongest blood pressure medicine, so it is possible that a low dose may not cause as dramatic an effect as you fear. But it might. And it isn't the strongest rate control medication either, so especially with a pacemaker in place, it may have a negligible effect. Talk with your doctors, but perhaps only you can weigh the potential risk/benefit.

    I completely understand that when you are already having to deal with so much impediment in your daily life with your injury already, then something so "small" as a hand tremor can be really really frustrating (and debilitating). My Dad hates it, and sometimes it really upsets him... especially when he is signing his name. But he's been trying to use the tricks, and he gets through most things he needs to do.
    Last edited by hlh; 01-17-2018 at 10:06 PM.

  3. #3
    Quote Originally Posted by gjnl View Post
    It seems to me that many spinal cord injured may experience these type tremors due to the injury.
    From what you describe it sounds like an essential tremor and not anything to do with your spinal cord injury.

    Out of pure curiosity, does it get better when you have an alcoholic beverage or two?

  4. #4

    Myelogram?

    Have you had a myelogram done on your spinal cord especially at the site of injury?

    You have neurological damage at C6. Do you have Honer's Syndrome?

    Horner's Symdrome only happens at trauma at C6 where the sympathetic trunk is damaged.

    Very easy to detect.

    Look in the mirror in average light. Is one pupil smaller than the other (miosis)?

    Is that eye lid a little droopy (ptosis)?

    Is so, you have trauma to the sympathetic nerves going up to the eyes. You have Horner's Symdrome. You may also have more damage at the site of injury.

    I have it.

    Ti
    "We must overcome difficulties rather than being overcome by difficulties."

  5. #5
    I too have benign familial ET. I take Mysoline (primidone) which helps some. Ask your neurologist about it.

    http://www.clevelandclinicmeded.com/...ology/tremors/

    Tremor is not a result of spinal cord injury. It most always occurs due to brain injury and often runs in families. People with MS may get tremor, but it is not associated with spinal cord lesions, instead with brain lesions due to MS.

    (KLD)
    Last edited by SCI-Nurse; 01-19-2018 at 03:25 AM.
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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