Essential Tremor, diagnosis and treatment: Implications for the elderly

1. Essential Tremor, diagnosis and treatment: Implications for the elderly Fenna Phibbs M.D. Assistant Professor of Neurology

2. Also known as�.. Familial tremor Benign essential tremor Intention tremor Hereditary tremor

3. What is Essential Tremor? A neurological disorder characterized by rhythmic, involuntary shaking of a part or parts of the body Most commonly seen in the arms/hands Can also be seen in the head, voice, legs and trunk

4. What is Essential Tremor? Action/Kinetic Tremor Occurs during voluntary action such as eating, drinking, writing Postural Tremor Occurs in positions against gravity such as holding your arms out in front of your body Internal sense of tremor

5. What is affected Body parts affected: Hands 69% Voice 40% Head 17% (no-no 79%) Leg 13% Jaw 7% Others-face trunk and tongue Can start at any age, which does not have bearing on the rate of progression Slowly progressive, defined as increased tremor amplitude and/or extension to previously unaffected body parts Not associated increased mortality

6. Genetics of ET 50% of patients have a family history Autosomal dominant pattern, most common

7. Prevalence Rate 4 to 5.6 percent of people aged 40 to 60 have ET Age 60 and older is estimated at 6.3 to 9%

8. (Benign) Essential tremor Disability Worse with anxiety, fatigue and illness Socially withdraw Physical disability related to age, tremor amplitude, ability to execute fine motor tasks such as writing and eating. Anxiety and depression Gait changes, possible dementia Medication side effects