WordNet

being or relating to or containing the essence of a plant etc; "essential oil"
absolutely necessary; vitally necessary; "essential tools and materials"; "funds essential to the completion of the project"; "an indispensable worker" (同)indispensable
basic and fundamental; "the essential feature"
not dangerous to health; not recurrent or progressive (especially of a tumor)
pleasant and beneficial in nature or influence; "a benign smile"; "the benign sky"; "the benign influence of pure air" (同)benignant
kindness of disposition or manner; "the benign ruler of millions"; "benign intentions"
shake with seismic vibrations; "The earth was quaking" (同)quake
shaking or trembling (usually resulting from weakness or stress or disease)
an involuntary vibration (as if from illness or fear) (同)shudder
a small earthquake (同)earth tremor, microseism

PrepTutorEJDIC

『絶対必要な』,欠くことのできない / 『本質の』,本質的な / (植物・薬剤などの)エキスの,精の / (…に)不可欠の要素;(…の)主眼点,要点《+『of』+『名』》
(心・表情などが)親切な,優しい / (事情・環境・気候などが)好適な,好都合な / 悪性でない
(地面などの)震動,揺れ / (恐怖・興奮などによる体・手足の)震う,身震い

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/19 16:19:36」(JST)

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Essential tremor (ET, also referred to as benign tremor or familial tremor or shaky hand syndrome) is the most common movement disorder; its cause is unknown. It typically involves a tremor of the arms, hands or fingers but sometimes involving the head, vocal cords or other body parts during voluntary movements such as eating and writing.^[1] It is distinct from Parkinson's disease—and often misdiagnosed as such—although some individuals have both conditions.^[1] Essential tremor is commonly described as an action tremor (it intensifies when one tries to use the affected muscles) or postural tremor (present with sustained muscle tone) rather than a resting tremor, such as is seen in Parkinson’s, which is usually not included among its symptoms.^[2]

Classification

This type of tremor is often referred to as "kinetic tremor".

Essential tremor has been known as "benign essential tremor", but the adjective "benign" has been removed in recognition of the sometimes disabling nature of the disorder.^[3]^[4]

Signs and symptoms

In mild cases, ET can manifest as the inability to stop the tongue or hands from shaking, the ability to sing only in vibrato, and difficulty to do small precise tasks such as threading a needle. Even simple tasks like cutting in a straight line or using a ruler can range from difficult to impossible, depending on the severity of the condition. In disabling cases, ET can interfere with a person's activities of daily living, including feeding, dressing, and taking care of personal hygiene. Essential tremor generally presents as a rhythmic tremor (4–12 Hz) that occurs only when the affected muscle is exerting effort. Any sort of physical or mental stress will tend to make the tremor worse.^[5]

The tremor may also occur in the head (neck), jaw and voice as well as other body regions, with the general pattern being that the tremor begins in the arms and then spreads to these other regions in selected patients. Women are more likely to develop the head tremor than are men. Other types of tremor may also occur, including postural tremor of the outstretched arms, intentional tremor of the arms and rest tremor in the arms.^[6] Some patients may have unsteadiness and problems with gait and balance.

ET-related tremors do not occur during sleep, but patients sometimes complain of an especially coarse tremor upon awakening that becomes noticeably less coarse within the first few minutes of wakefulness. Tremor and disease activity/intensity can worsen in response to fatigue, strong emotions, low blood sugar, cold and heat, caffeine, lithium salts, some antidepressants, and other factors. It is typical for the tremor to worsen in "performance" situations, such as when writing a check for payment at a store or giving a presentation.

Parkinson's disease and Parkinsonism can also occur simultaneously with ET.^[1] In those cases the degree of tremor, rigidity, and functional disability does not differ from those people with idiopathic Parkinson's disease. Hand tremor predominates (as it does in Parkinson’s disease), and occurs in nearly all cases, followed by head tremor, voice tremor, neck, face, leg, tongue and trunk tremor. Most other tremors occur in association with hand tremor. Walking difficulties in essential tremor are common. About half of patients have associated dystonia, including cervical dystonia, writer's cramp, spasmodic dysphonia, and cranial dystonia, and 20% of the patients had associated parkinsonism. Olfactory dysfunction (loss of sense of smell) is common in Parkinson’s disease, and has also been reported to occur in patients with essential tremor. A number of patients with essential tremor also exhibit many of the same neuropsychiatric disturbances seen in idiopathic Parkinson's disease.^[7]

Cause

The underlying etiology of essential tremor is not clear but many cases seem to be familial.^[8] Approximately one-half of the cases are due to a genetic mutation and the pattern of inheritance is most consistent with autosomal dominant transmission. No genes have been identified yet but genetic linkage has been established with several chromosomal regions.^[9]^[10] A number of environmental factors, including toxins, are also under active investigation as they may play a role in the disease's etiology.^[11]

In terms of pathophysiology, clinical, physiological and imaging studies point to an involvement of the cerebellum and/or cerebellothalamocortical circuits.^[12] Changes in the cerebellum could also be mediated by alcoholic beverage consumption. Purkinje cells are especially susceptible to ethanol excitotoxicity.^[13] Impairment of Purkinje synapses is a component of cerebellar degradation that could underlie essential tremor.^[13]

Recent post mortem studies have evidenced alterations in LINGO1 (Leucine rich repeat and Ig domain containing 1) gene^[14]^[15] and GABA receptors ^[16] in the cerebellum of people with essential tremor.

Diagnosis

Usually the diagnosis is established on clinical grounds. Tremors can start at any age, from birth through advanced ages (senile tremor).^[17]^[18] Any voluntary muscle in the body may be affected, although the tremor is most commonly seen in the hands and arms and slightly less commonly in the neck (causing the patient's head to shake), tongue, and legs. A resting tremor of the hands is sometimes present.^[19]^[20] Tremor occurring in the legs might be diagnosable as Orthostatic Tremor.

ET does not usually occur in combination with other neurological disorders (except for rare instances of associated Parkinsonism); it is thought to be a mono-symptomatic disease.^[21]^[22]

Treatment

Not all individuals with ET require treatment, but there are many treatment options depending on symptom severity.^[1] Caffeine and stress should be avoided, and good sleep is recommended.^[1]

When symptoms are sufficiently troublesome to warrant treatment, the first medication choices are beta blockers such as propranolol or alternately, nadolol and timolol. Atenolol and pindolol are not effective for tremor.^[1] The anti-epileptic primidone is also effective for ET.^[1]

Second-line or third-line medications can be added if the first-line medications do not control the tremor. Second-line medications are the anti-epileptics topiramate, gabapentin and levetiracetam, or benzodiazepines like alprazolam. Third-line medications are clozapine and mirtazapine.^[1]

When medications do not control the tremor or the patient does not tolerate medication, botulinum toxin, deep brain stimulation or occupational therapy can be helpful.^[1] The electrodes for deep brain stimulation are usually placed in the "tremor center" of the brain, the ventral intermediate nucleus of the thalamus. In addition, an emerging treatment being offered in some places is High Intensity Focused Ultrasound (HIFU) which has shown some promise in treatment (Elias et al. 2013).

Prognosis

Although essential tremor is often mild, patients with severe tremor have difficulty performing many of their routine activities of daily living.^[3]^[4] ET is generally progressive in most cases (sometimes rapidly, sometimes very slowly), and can be disabling in severe cases.^[23]^[24]^[25]

Epidemiology

ET is one of the most common neurological diseases, with a prevalence of approximately 4% in persons age 40 and older and considerably higher among persons in their 60s, 70s, 80s, and 90s.^[26] Aside from enhanced physiological tremor, it is the most common type of tremor and one of the most commonly observed movement disorders.^[27]

Society and culture

The actress Katharine Hepburn (1907–2003) had an essential tremor, which she inherited from her grandfather,^[28] that caused her head—and sometimes her hands—to shake.^[29]^[30]^[31] According to Dickens (1990), the tremor was noticeable by the time of her performance in the 1979 film The Corn is Green, when critics mentioned the "palsy that kept her head trembling".^[32] Hepburn's tremor worsened in the 1980s, when she was in her 70s to 80s.^[30]

Research directions

Harmaline is a widely used model of essential tremor (ET) in rodents.^[33] Harmaline is thought to act primarily on neurons in the inferior olive (IO). Olivocerebellar neurons exhibit rhythmic excitatory action when harmaline is applied locally.^[33]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Abboud H, Ahmed A, Fernandez HH (December 2011). "Essential tremor: choosing the right management plan for your patient". Cleve Clin J Med 78 (12): 821–8. doi:10.3949/ccjm.78a.10178. PMID 22135272.
^ "LINGO1 variant responsible for essential tremors and Parkinson's disease". news-medical.net. Retrieved October 27, 2014.
^ ^a ^b Bain PG, Mally J, Gresty M, Findley LJ (1993). "Assessing the impact of essential tremor on upper limb function". J Neurol 241: 54–61. doi:10.1007/bf00870673.
^ ^a ^b Louis ED, Barnes LF, Albert SM, Cote L, Schneier F, Pullman SL, Yu Q (2001). "Correlates of functional disability in essential tremor". Mov Disord 16: 914–920. doi:10.1002/mds.1184.
^ "Essential Tremor Treatment at the Johns Hopkins Movement Disorders Center in Baltimore, MD". hopkinsmedicine.org. Retrieved October 27, 2014.
^ Louis ED (2001). "Clinical Practice: Essential tremor". N Engl J Med 345: 887–891. doi:10.1056/nejmcp010928.
^ "Essential tremor as a neuropsychiatric disorder. - PubMed - NCBI". ncbi.nlm.nih.gov. Retrieved October 27, 2014.
^ Deng H, Le W, Jankovic J (2007). "Genetics of essential tremor". Brain 130 (6): 1456–1464. doi:10.1093/brain/awm018.
^ Higgins JJ, Pho LT, Nee LE (1997). "A gene (ETM) for essential tremor maps to chromosome 2p22-p25". Mov Disord 12: 859–864. doi:10.1002/mds.870120605.
^ Gulcher JR, Jonsson P, Kong A et al. (1997). "Mapping of a familial essential tremor gene, FET1, to chromosome 3q13". Nature Genetics 17: 84–87. doi:10.1038/ng0997-84.
^ Louis ED (2001). "Etiology of essential tremor: Should we be searching for environmental causes?". Mov Disord 16: 822–829. doi:10.1002/mds.1183.
^ Louis ED, Vonsattel JP (2007). "The emerging neuropathology of essential tremor". Mov Disord 23: 174–182. doi:10.1002/mds.21731.
^ ^a ^b Mostile, G.; Jankovic, J. (2010). "Alcohol in essential tremor and other movement disorders". Movement Disorders 25 (14): 2274–2284. doi:10.1002/mds.23240. PMID 20721919. edit
^ Delay, Charlotte,; Tremblay, Cyntia et al. (2014). "Increased LINGO1 in the cerebellum of essential tremor patients". Mov Disord 29: 1637–1647. doi:10.1002/mds.25819. PMID 24531928.
^ Kuo, SH,; Tang G. et al. (2013). "Lingo-1 expression is increased in essential tremor cerebellum and is present in the basket cell pinceau". Acta Neuropathol 125 (6): 879–89. doi:10.1007/s00401-013-1108-7. PMID 23543187.
^ Paris-Robidas, Sarah; Brochu E. et al. (2012). "Defective dentate nucleus GABA receptors in essential tremor". Brain 135 (Pt 1): 105–16. doi:10.1093/brain/awr301. PMID 22120148.
^ Louis ED, Dure L, Pullman S (2001). "Essential tremor in childhood". Mov Disord 16: 921–923. doi:10.1002/mds.1182.
^ Bain PG, Findley LJ, Thompson PD, et al. A study of hereditary essential tremor. Brain. August 1994;117(4):805-824.
^ Cohen O, Pullman S, Jurewicz E, Watner D, Louis ED (2003). "Rest tremor in essential tremor patients: Prevalence, clinical correlates, and electrophysiological characteristics". Arch Neurol 60: 405–410. doi:10.1001/archneur.60.3.405.
^ Rajput AH, Rozdilsky B, Ang L, Rajput A (1993). "Significance of Parkinsonian manifestations in essential tremor". Can J Neurol Sci 20: 114–117.
^ "Medscape: Medscape Access". emedicine.medscape.com. Retrieved October 27, 2014.
^ Bope, E.T.; Kellerman, R.D. (2013). Conn's Current Therapy 2014: Expert Consult: Online. Elsevier Health Sciences. ISBN 9780323225724. Retrieved October 27, 2014.
^ Critchley M (1949). "Observations on essential (heredofamilial) tremor". Brain 72: 113–139. doi:10.1093/brain/72.2.113.
^ Busenbark KL, Nash J, Nash S, Hubble JP, Koller WC (1991). "Is essential tremor benign?". Neurology 41 (12): 1982–1983. doi:10.1212/wnl.41.12.1982.
^ Louis ED, Ford B, Barnes LF (2000). "Clinical subtypes of essential tremor". Arch Neurol 57: 1194–1198. doi:10.1001/archneur.57.8.1194.
^ Louis ED, Ottman R, Hauser WA (1998). "How common is the most common adult movement disorder?: Estimates of the prevalence of essential tremor throughout the world". Mov Disord 13: 5–10. doi:10.1002/mds.870130105.
^ Benito-Leon J, Louis ED (2006). "Essential tremor: emerging views of a common disorder". Nat Clin Pract Neurol 2: 666–678. doi:10.1038/ncpneuro0347.
^ Healy, David (director) (18 January, 1993). "Katharine Hepburn: All About Me". Turner Network Television. Check date values in: |date= (help); Missing or empty |title= (help)
^ Claiborne Ray C (July 22, 2003). "Q & A; Head and Hand Tremors". The New York Times. Retrieved November 3, 2013.
^ ^a ^b Berg AS (2004 edition [First published 2003]). Kate Remembered: Katharine Hepburn, a personal biography. London: Pocket. p. 260. ISBN 0-7434-1563-9. Check date values in: |date= (help)
^ Conova S (January 29, 2003). "Stopping essential tremor". In vivo (Columbia University Health Sciences) 2 (2).
^ Dickens H (1990 edition [First published 1971]). The Films of Katharine Hepburn. New York City, NY: Carol Publishing Group. p. 31. ISBN 0-8065-1175-3. Check date values in: |date= (help)
^ ^a ^b Miwa, H. (2007). "Rodent models of tremor". The Cerebellum 6 (1): 66–72. doi:10.1080/14734220601016080. PMID 17366267. edit

External links

Essential tremor at DMOZ

UpToDate Contents

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1. 本態性振戦の薬理学的治療 pharmacologic treatment of essential tremor
2. 振戦の概要 overview of tremor
3. 本態性振戦の外科治療 surgical treatment of essential tremor
4. 小児における運動過多な運動障害 hyperkinetic movement disorders in children
5. パーキンソン病の診断 diagnosis of parkinson disease

English Journal

Reversing the polarity of bipolar stimulation in deep brain stimulation for essential tremor: A theoretical explanation for a useful clinical intervention.

Yousif N, Pavese N, Naushahi MJ, Nandi D, Bain PG.Author information a Department of Medicine , Centre for Neuroscience, Imperial College London , London , UK.AbstractThe quadripolar electrodes used for deep brain stimulation are designed to give flexibility in contact configuration, optimize therapeutic effect, and minimize side-effects. A patient with essential tremor did not tolerate a bipolar setting due to the emergence of a pulling sensation in her face. However, when the polarity of the contacts was reversed, a 70% higher voltage was tolerated. Using an electric field model, we predicted that this effect was due to the proximity of the topmost contact to the internal capsule. Post-operative imaging supported this prediction. These results demonstrate how a multi-disciplinary approach allows us to optimize parameter settings.
Neurocase.Neurocase.2014 Feb;20(1):10-7. doi: 10.1080/13554794.2012.713495. Epub 2012 Sep 24.
The quadripolar electrodes used for deep brain stimulation are designed to give flexibility in contact configuration, optimize therapeutic effect, and minimize side-effects. A patient with essential tremor did not tolerate a bipolar setting due to the emergence of a pulling sensation in her face. Ho
PMID 23003326

Lithium tremor revisited: pathophysiology and treatment.

Baek JH, Kinrys G, Nierenberg AA.Author information Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, MA, USA.AbstractOBJECTIVE: Tremor occurs frequently as a side-effect of lithium, and it is, however, easily overlooked in the clinical setting. In this article, we attempt to review the pathophysiology and the clinical approach of lithium tremor.
Acta psychiatrica Scandinavica.Acta Psychiatr Scand.2014 Jan;129(1):17-23. doi: 10.1111/acps.12171. Epub 2013 Jul 3.
OBJECTIVE: Tremor occurs frequently as a side-effect of lithium, and it is, however, easily overlooked in the clinical setting. In this article, we attempt to review the pathophysiology and the clinical approach of lithium tremor.METHOD: We searched the Pubmed and Cochrane Library for relevant artic
PMID 23834617

Rationale and clinical pearls for primary care doctors referring patients for deep brain stimulation.

Martinez-Ramirez D, Okun MS.Author information University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Fla., USA.AbstractBackground: Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a brain lead connected to a chest-based neurostimulator similar to a cardiac pacemaker. The device can be programmed to deliver electrical impulses to neuromodulate abnormal brain circuitry in disorders such as Parkinson's disease (PD), essential tremor (ET), and dystonia. As the number of patients receiving DBS surgery increases, it will be important for primary care doctors to identify reasonable DBS candidates for referral to an experienced center. Objective: To provide primary care physicians with a rationale and also to provide clinically useful pearls for referral of potential DBS candidates. Methods: A complete PubMed review of the literature. Results: This review will be focused on PD and ET and will address the following issues: what are the common motor and nonmotor symptoms? What is the evidence supporting the use of DBS in PD and ET? What is the importance of a multi- or interdisciplinary DBS team for patient selection? What can be done to improve success in identifying and referring potential DBS candidates? Conclusion: DBS is a highly effective therapy for select candidates with PD and ET. The most important factor influencing DBS outcome is proper patient selection. It will be critical as DBS continues to be more commonly employed for primary care doctors to select candidates from their practices as appropriate referrals to specialized centers. © 2013 S. Karger AG, Basel.
Gerontology.Gerontology.2014;60(1):38-48. doi: 10.1159/000354880. Epub 2013 Oct 25.
Background: Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a brain lead connected to a chest-based neurostimulator similar to a cardiac pacemaker. The device can be programmed to deliver electrical impulses to neuromodulate abnormal brain circuitry in disorders su
PMID 24193201

Japanese Journal

<原著>Familial essential myoclonus and epilepsy (FEME) の臨床遺伝学的検討と連鎖解析

鈴木隆
新潟医学会雑誌 116(11), 535-545, 2002-11-10
… Familial essential myoclonus and epilepsy (FEME) is hereditary epileptic disorder characterized by adult-onset, tremor-like postural myoclonus, spontaneous myoclonus, infrequent convulsive seizures and benign clinical course. … Benign adult familial myoclonic epilepsy (BAFME) and Familial adult myoclonic epilepsy (FAME) are autosomal dominant myoclonic epilepsy, and these clinical picture are similar to that of FEME. …
NAID 110004462754