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A very close look at the lives and brains of a few very dedicated research participants at UCSD may reveal a more complete picture of Essential Tremor (ET).

ET is one of the most common movement disorders. It is characterized by tremor of the hands and forearms (although it may also affect the head, neck, legs, voice, or face), occurring during voluntary movements such as drinking, pouring, eating, or writing. Despite a growing body of research, the neurology of ET is still poorly understood. Emerging studies suggest that cognitive impairments, personality changes, and a lower quality of life often accompany this disease. Yet, the underlying anatomical structures and brain networks responsible for Essential Tremor and its behavioral manifestations are still unclear. The Brain Observatory is working with a very dedicated small group of local research participants who live in San Diego. In line with our trademark multimodal approach, we assess their neurological conditions and neuropsychological profile, and collect structural magnetic resonance imaging (sMRI) data, including diffusion weighted imaging (DTI), on a regular basis. We also use a new instrument to record the frequency and amplitude of the tremor. With all of these methods combined, we hope to be able to draw a complete picture of this disease for each patient.

There are many questions about ET that remain unanswered. Most notably, unlike in other movement disorders, like Parkinson’s disease, the pathogenesis of ET is still not well characterized. Amongst the several brain structures that have been proposed to play a role in ET are the cerebellum, the brainstem, the frontal lobes, and the thalamus. It may also be that a dysfunction in neural pathways connecting these areas causes the symptoms observed in ET. Support for these theories comes from neuroimaging, neuropsychological, as well as neuropathological studies. DTI studies have revealed widespread white matter pathology in the brains of ET patients. Neuropsychological studies have pointed into the direction of prefrontal cortex dysfunction. The successful treatment of ET by means of deep brain stimulation of the thalamus suggests that this subcortical structure may be involved. Transmagnetic stimulation of the cerebellum, as well as the consumption of ethanol (affecting cerebellar function) has been found to temporarily relieve tremor symptoms. All these studies have brought us closer to understanding ET. However, to-date no one has combined available imaging methods and experimental approaches. The Brain Observatory is unique in that we are able to work with a selected group of subjects who live with ET and who are committed to finding out what is happening in their brain. Also, by working closely with our cohort of subjects, we will have the chance to learn how differently ET affects each person in the performance of daily tasks and how it may impact their personal life. The examination of multiple family members will allow us to evaluate the genetic influence on the phenotype. The goal is to combine results from different research approaches to achieve a more integrated, more complete picture of ET.

But this picture may not be static. What is the impact of ageing on ET? The possibility that ET is a progressive neurodegenerative disease is still being debated. Previous research has shown that advanced age is associated with an increased risk of developing ET and that ET is associated with a faster cognitive decline than that seen in healthy control subjects. Moreover, older-onset ET has been linked to an increased risk of developing dementia. It would be important to distinguish between the neurological markers of the tremor and those structural changes that occur as a consequence of aging. A rigorous, morphometric longitudinal imaging study conducted on the same subjects, combined with accurate quantitative diagnosis, could provide the data that is necessary to understand the long-term temporal dynamics of the tremor and how factors such as age and personal habits affect its progression.

Perhaps the most important aspect of the ongoing research is that our friends have made the generous decision to donate their brains after they pass away, which will allow us to establish the crucial link between the information collected during the study with the direct examination of the brain. Histo-pathologic changes associated with ET are currently grouped into two distinct phenomena; Purkinje cell loss in the cerebellum and presence of Lewy bodies in the brainstem. Both these structural changes are hallmarks of neuronal loss and degeneration, which would indicate that ET is indeed a progressive and predictable neurological disorder. Yet, post-mortem studies of ET are still very limited and need to be integrated within a bigger picture. Our research project will ultimately allow us to combine neurobehavioral information with the direct observation of the brain in the same individual. In time, these well-studied individuals with ET will be preserved in The Digital Brain Library (http://thebrainobservatory.ucsd.edu/content/digital-brain-library-0), making all data accessible to other researchers for comparisons and retrospective collaborative studies.

The Brain Observatory welcomes the participation of other patients whose life is being affected by Essential Tremor in this preliminary phase of the work. Extending the study to a larger number of subjects means adding significance and reliability to our study. In other words, the larger the group of participants the higher the potential impact of our study.

For more information, please contact us by phone or by e-mail.

Article by Ruth Klaming and Jacopo Annese

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My hands aren’t ever steady

My hands aren’t ever steady as such whether holding a glass, flower or camera. I know they can’t stay at a place and be absolutely steady. Don’t know if it’s ET but I certainly get a good shake up when asleep at times. casino online australia casino online australia



tremor, migraine, eye disturbances, confusion and I'm only 53

Tremor, migraine, eye disturbances, confusion and I'm only 53. I have had visible tremor in my hands and the feeling of tremor throughout my body that makes me unsteady and weak. I have seen many doctors over the years and 15 in the last 2 years. I finally have a band-aid solution that worked for 3 months and is now failing over time (I think it's been 5 months). I take effexor for body control and leg fatigue, along with adderall for both body control, severe fatigue and ability to think. I take trazadone and klonopin for sleep, and sumatriptan for migraines. I eat a very healthy diet, I'm 5'2" and 111 lbs. I exercise almost every day, either hiking or yoga. Before these medications I could barely leave the house for 2.5 years, I had to pull myself up the stairs just to get to our second level. My relationships with my husband and friends are deteriorating because I am usually ill at least 1/2 the day and sometimes the whole day. I have great work skills but my health is too unpredictable to hold down a job. Is there any help?



More information on Essential Tremor

 

Thank you for your interest in our research and sharing your personal experience with tremor. We are running a focused study on Essential Tremor as we are interested in finding out more about what happens in the brains of individuals with ET. Because our attention is solely on research, we are not qualified to provide diagnosis or treatment. The International Essential Tremor Foundation (IETF) is a great source for information on diagnosis, treatment, coping strategies, and many other questions you may have about Essential Tremor. You can also find links to support groups in your area. 




Essential Tremor

I have lived with this since as early as I can remember, my daughter also has ET and it started I like between 14-16 year of age. I would be interested in more information. My daughter was the one that posted the link on her FB page.



International Essential Tremor Foundation

 

Thank you for your interest in ET research. We are working with the International Essential Tremor Foundation (IETF), an organization that is dedicated to ET research and support for those that are affected by this tremor disorder. The IETF has a very comprehensive website that provides you with educational information about ET, its treatment, support groups, and much more. 




Any medical condition can be

Any medical condition can be scary, but it is particularly worrisome when one either doesn't know what is causing their declining health or how to fix it. It is good to see those who are working on ET research post in the comments and let people know that someone is out there trying to unearth information about combating this condition. It seems like a condition that spans from teenage years to one's silver or senior years. This is a scarily large demographic. However, from a research standpoint, the more people who come forward from different age groups will help enlarge the pool available to research. With a large enough sample size, researchers can hopefully narrow down potential causes and begin offering treatment that improves the life of those suffering from these tremors.




Essential Tremor

I too have lived with this since my earliest grade school memories. I could never write smoothly or draw like everyone else around me. I have had countless panic attacks every time that I had to fill out a form or even sign my name. I'm now 62 years old and finally started talking about it with family. If you have time, please tell me a little more about your experience. I have 3 sisters and they don't have this problem. Regards, Keith



ESSENTIAL TREMOR & REFLEXOLOGY

Good day My son (17) suffers from ET. Final year at school. Very difficult to write and learn. Nausius, head aces, tremors, lack of interest. He is very clever, but the ET makes him very negative. Medication makes it even worse, it is making him depressed and tired if medication starts to work out. Any results with Reflexology? Regards VT



pathogenesis of ET

We actually have a lot of advanced methods and equipments in medical science now. It is sad to hear that the pathogenesis of ET is still not well characterized till date. I hope this will be resolved soon. Regards. 




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