Shaky Drawing

Are essential tremors really essential?

My left hand tremors began about 30 years ago. The right hand joined in awhile later in a much attenuated sort of way. Good thing I did not pursue a career in surgery, but attentive patients, now and then, would ask me if I was nervous as my left hand picked up whatever with mild to wild shaking. Good thing also that I can mostly produce a decent signature when required.

Are essential tremors really essential? Per dictionary definition one, no, they are not necessary (and most definitely unwanted). Per dictionary definition 2, they are idiopathic, originating from some unknown neurological mix-up. The one definite exception as to origin, with no thanks to my dad who did, in all fairness, bequeath me with other useful skills, is the genetic path.

The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. A defective gene from just one parent is needed to pass on the condition. If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.

The tremor mostly affects the upper limbs, followed by head movements. I am in a classy tremor cohort with Kathryn Hepburn, but at least my chin and voice don’t quiver:

Actress Katharine Hepburn (1907–2003) had an essential tremor, which she inherited from her grandfather, that caused her head—and sometimes her hands—to shake. 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".

The magnitude of shaking varies, for me the worst is in the AM, especially with coffee which I drink anyway. We do crosswords during breakfast, and somedays I have to leave the fill-in-the-blanks to my partner as my E’s turn into horizontal flags flapping wildly in the breeze. If my left hand picks up a cup of liquid that is too light, here’s what happens if the right hand does not come immediately to lefty’s rescue. And believe me, the increased movements of awesome strength spew coffee everywhere.

The raters were all greatly impressed by what looked like intermittent "jumps" of the patients' hands. These infrequent, "aperiodic" but sudden increases in tremor amplitude would be the events most likely to cause a patient to spill a cup of coffee or ruin a piece of writing. P.G.Bain et al, “Assessing Tremor Severity”

Their study used the Bain and Findley spiral score among other rating scales. B&F simply requires the subject to draw a spiral. No need to point out the shaky hand.

I, on the other hand, prefer to make shaky dog portraits.

According to the research using B&F spiral scores, ET tend to get worse over time. Especially to those who have a familial history which also tends to occur earlier in life than the idiopathic variety. Two medications are notable for some relief in the magnitude of the shaking. I use propranolol, a beta blocker initially used for hypertension, then prescribed for stage fright or any sort of stressful situation. Another medication, Primidone, an anti-convulsant, is also useful to decrease this unwanted bodily rocking and rolling:

Primidone, 50 to 1,000 mg/d, reduced the amplitude of essential tremor in both untreated and propranolol-treated patients. Low doses were as effective as high doses. Primidone decreased tremor more than propranolol.

ET can occasionally get quite severe. Neurosurgery procedures such as deep brain stimulation have shown success in relieving the tremor.

I think I’ll just shake my way day to day instead.