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Medical Edge Newspaper Column from Mayo Clinic

DEEP BRAIN STIMULATION CAN HELP ESSENTIAL TREMOR

DEAR MAYO CLINIC: My grandfather’s hands shook so badly he couldn’t shave without cutting himself. So when my own hands began shaking when I was about 10, I thought it was just something that ran in our family.

I am now 52 years old and recently sober. Now that I don’t drink, my hands are shaking more than ever — my head, too, a little. My doctor says I have Essential Tremor. At the alcohol treatment center, they thought it might be Parkinson’s disease. Any comment? – Denver

ANSWER: Essential Tremor is an inherited movement disorder that affects an estimated 5 million people in the United States, most of them age 60 or older. While it can affect almost any part of the body, it occurs most often in the hands, especially during tasks that demand close attention and control, such as cutting with scissors, writing or shaving. In some cases, the head, voice and arms are also affected.

Although the trembling symptoms can be confused with Parkinson’s disease, ET is fundamentally different. Unlike Parkinson’s, ET has a pronounced tendency to run in families. It also can occur at any point in a person’s life. Parkinson’s disease is strongly associated with advanced age. ET is five to 10 times as common as Parkinson’s.

You point to another typical aspect of ET. It starts out mildly, so most people don’t really pay attention to it. People just assume that everyone puts up with a little shaking. Another feature you may have discovered is that consumption of alcohol seems to temporarily control the shaking.

The tremor is caused by circuits in the brain that fire abnormally, but no one knows why the firing pattern is off. Neurosurgeons can actually listen to the electrical firing of the nerve cells with small electrodes. And if neurosurgeons interrupt this misfiring — introducing a small electrical current through an electrode implanted in the brain — the tremor can be minimized or stopped as long as the current is on. This treatment is a relatively new surgical procedure known as Deep Brain Stimulation.

Unfortunately, there is no known treatment that can “fix” the underlying disorder. While several medications are available that help control the tremor, they often have side effects that many patients find nearly as disabling as the shaking. Among the side effects are grogginess, sedation, depression and low blood pressure.

A thorough medical evaluation, including careful attention to family history with physicians familiar with ET and Parkinson’s disease, should help you plot your next health care step.

Ryan Uitti, M.D., Neurology, and Robert Wharen Jr., M.D., Neurologic Surgery;
Mayo Clinic, Jacksonville, Fla.

Additional Resources:
Deep Brain Stimulation
Appointment Information
More Information on Essential Tremor

DEAR MAYO CLINIC: My 6-year-old son has a hard time speaking and being understood. We held him back from starting kindergarten to give his speech a chance to develop, and it did somewhat. So it was a complete shock for us that, when he finally did start public-school kindergarten, the teacher recommended a speech therapist.

We met with the therapist, and she wants us to have him evaluated for something called speech apraxia. She said she went to a conference on it where she learned Mayo Clinic is a leading center for it. What is childhood apraxia? — Washington

ANSWER: Childhood apraxia is a motor disorder of speech. It may affect as many as 3 to 5 percent of children under age 5 with speech disorders. It sometimes arises from injury to the posterior portion of the frontal lobe of the brain’s left hemisphere. Often there is no obvious cause.

Children with apraxia know what they want to say but have difficulty saying it because of impaired motor-planning abilities. These motor-planning and programming skills involve coordinating all the refined movements of the tongue, lips, jaws and palate necessary for speech. Children with apraxia have trouble getting these structures in the right initial position, and then producing the sequence of movements needed for continuous speech.

The great news is that these kids do well with therapy, especially if they are diagnosed early, and get therapy from a professional with specific training and experience in this disorder. Treatment approaches that emphasize frequent therapy sessions, and lots of practice within each session, are most successful.

Edythe Strand, Ph.D., Speech Pathology and Neurology; Mayo Clinic, Rochester, Minn.

Additional Resources:
Speech Apraxia
Appointment Information

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.