Talk:Essential tremor

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 7 January 2019 and 25 April 2019. Further details are available on the course page. Student editor(s): Alexandria.ford.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 20:52, 16 January 2022 (UTC)

Harmane??

I don't think harmanes are the chemical from grilled meats that are a potential cause. When you click on the link for that, you get redirected to a very specific plant. "Heterocyclic amines " seem to be the chemical made by high temperature grilling that people worry about causing cancer: http://health.howstuffworks.com/diseases-conditions/cancer/facts/10-cancer-myths1.htm

Also barbecued meats would not be the same as grilled meats - barbecuing is a process that involves cooking meat at a very low temperature for a long period of time. I know that in some parts of the globe barbecuing and grilling is considered synonomous, but for those who live in barbecue country (the US south), this would be confusing. —Preceding unsigned comment added by 204.65.182.238 (talk) 15:09, 12 August 2010 (UTC)

Makes No Sense

"Essential tremor (ET) generally presents as a rhythmic tremor (4-12 Hz) that is present only when the affected muscle is exerting effort (i.e., it is not present at rest). Any sort of physical or mental stress will tend to make the tremor worse, often creating the false impression that the tremor is of somatic origin."

This sentence doesn't really make any sense. It seems to be trying to say that there is an impression that ET is of a psychological origin, but instead say "somatic origin." As I'm sure we all know, "soma" refers to the body, not the mind. I'm not changing it because I don't have any background in this topic, I just recognize this sentence as illogical.

It has been changed now. Zuiram 05:20, 15 December 2006 (UTC)

Good! I agree with the change. Wcmead3 (talk) 10:52, 28 August 2023 (UTC)

anecdotal vs. some

Anecdotal reports are case studies. "Some reports", as the entry read before, could also include group studies. No POV is implied either way. Pilatus 15:38, 10 September 2005 (UTC)

Speaking of anecdotal reports, one of my customers found that a delayed auditory feedback (DAF) anti-stuttering device helped his laryngeal tremors. But I tried this with another person with laryngeal tremors and the device had no effect. I vaguely recall that the first person had both stuttering and essential tremors.-Tdkehoe 23:44, 13 January 2006 (UTC)

spam, copyvio or something else?

There is a section in here that reads "At WE MOVE, we believe" and so forth. Since WP is not WE MOVE, it would appear this text has either been copied, or has been inserted by the organization in question. Otherwise, it's just unencyclopaedic. Could someone try to sort this out? Zuiram 05:24, 15 December 2006 (UTC)

I've cleaned that section up a bit. Chovain 06:44, 15 December 2006 (UTC)

source

Was googling information on this (I have it)...

The section that requires a source "Tremor intensity can worsen in response to fatigue, strong emotions, hunger, cold, or other factors and can be reduced with alcohol in approximately 50 percent of patients.[citation needed] However, an over-reliance on alcohol to control tremor symptoms can sometimes lead to alcohol addiction."

I found this same information at http://www.healthatoz.info/diseases/benign-essential-tremor.htm but I'm unsure if it's a valid source, if someone wants to check it and add, please do. Koptor 21:34, 26 February 2007 (UTC)

Citations

I noticed that the template regarding the citation style of this article had been added to the article page instead of the talk page (here). I have moved the template to the top of this page. *Vendetta* _{(user talk contrb)} 05:41, 19 March 2007 (UTC)

Just an FYI

(I contributed much of the original body of the article (that you folks have vicously attacked ;) )

But anyway, my case of ET, while relatively typical in most aspects, shows no obvious genetic basis. However, I have learned that I probably had a mild case of polio as a young child, and likely this is the cause of my tremor. Since "occult polio" is fairly common in 50-60-70-something folks, I wouldn't be surprised if a significant fraction of the idiopathic cases are due to occult polio. drh 23:45, 5 May 2007 (UTC)

---

Surgical treatments (which are generally reserved for the most severe cases)

The case can be as severe as a doctor or patient might think it is, the surgeon can only help when there is something to operate. maybe it only seems wrong in the article to me so just because i'm not native english speaker? Avjoska (talk) 10:01, 2 August 2008 (UTC)

Alcohol as mechanism for ET/Memantine as a therapeutic drug

This page includes alcohol as a possible remedy for essential tremor. However, there is evidence that suggests alcohol can also be an agent in the development of the disease due to its negative effects on cerebellar circuitry. I edited this page to include this information so that it’s known that alcohol may play a dual role in the pathology of this disease. I integrated this information into the "causes" section.

I also provided a link under the “medications” section to a different page “Long-term effects of alcohol” so that people can get a more in-depth cellular mechanism by which alcohol exerts ameliorative effects. I included information about another potential drug, specifically memantine, that have been used in experimental studies that may soon be used in clinical trials for ET treatment.

Lastly, I added a section regarding the animal models used to study ET and what these studies have told us. JChanelo (talk) 01:33, 13 December 2011 (UTC)

Hepburn's tremor

A user asked me to provide a bit of detail about Katharine Hepburn's tremor, and the fact that it was only visible in her later years. Berg's mention of it can be seen here. The following source also writes (regarding her work on The Corn is Green, 1979) "More than one critic commented on the palsy that kept her head trembling":

Dickens, Homer (1990 edition [First published 1971]). The Films of Katharine Hepburn. New York City, NY: Carol Publishing Group. p. 31. ISBN 0-8065-1175-3. {{cite book}}: Check date values in: |year= (help)CS1 maint: year (link)

So that could be used to support the fact that the tremor became seriously pronounced in her early 70s. It was definitely visible before then (there are even hints of it in Guess Who's Coming to Dinner, 1967) but I'm yet to find a source that states this outright. Also, the following source can be used to support the fact that she inherited in from her grandfather, if you like:

Healy, David (director) (18 January, 1993). "Katharine Hepburn: All About Me". Turner Network Television. {{cite episode}}: Check date values in: |airdate= (help); Missing or empty |series= (help)

--Loeba (talk) 22:11, 3 November 2013 (UTC)

Thanks, Loeba. I think I got it all now; how does this look? SandyGeorgia (Talk) 22:31, 3 November 2013 (UTC)

No worries. I tweaked the wording a bit, is it okay? --Loeba (talk) 22:42, 3 November 2013 (UTC)

Much better-- thanks so much! Smoother, nicer, better flow. I've just discovered (through "what links here") that Charles M. Schulz (Peanuts comics) and Robert Byrd (senate majority leader) had essential tremor, but per WP:MEDMOS we add cases of people who "lastingly affected the popular perception of a condition" ... it affected Schulz's signature, but I don't think most people know that, and I don't think most people think of Byrd's tremor in the same way as Hepburn ... that is, she is the notable person most people would associate with the tremor. Thanks again, SandyGeorgia (Talk) 22:52, 3 November 2013 (UTC)

"Shaky hand syndrome"

There is not even one peer-reviewed journal article that calls essential tremor "shaky hand syndrome." See https://scholar.google.com/scholar?q=%22shaky+hand+syndrome%22&btnG=&hl=en&scisbd=1&as_sdt=0%2C5 — Preceding unsigned comment added by 97.65.119.186 (talk) 01:54, 19 November 2015 (UTC)

MRI-guided high intensity focused ultrasound

IMO, this content is not well adjusted to the conclusions of the sources, especially regarding to matters not yet resolved:

Additionally, MRI-guided high intensity focused ultrasound is a non-surgical treatment option that shows to be safe and effective, but has limited availability. Adverse events are observed in some patients, including gait difficulties, balance disturbances and paresthesias, but it is certainly an option now available. With this procedure the results are typically observed immediately, it requires no general anesthesia, does not require a hospital stay and the patient can promptly return to normal life.

Let's see more opinions.

Best regards. --BallenaBlanca (Talk) 22:54, 24 May 2017 (UTC)

Thank you for your note, the editing seems a little excessive since important information was left out. Regarding to matters not yet resolved through research, I agree the article could make clear that "More long-term follow-up data are needed to establish clearly the role of this method in ET therapy" (Hedera, 2017), but the information written before and the description about this procedure as an option for patients should not be eliminated, since "MRgFUS is a promising new surgical approach with a number of unknowns and unsolved issues. It represents a valuable option particularly for patients who refused or could not be candidates for other procedures, deep brain stimulation in particular. MRgFUS seems to be an outstanding achievement in interventional neurology and functional neurosurgery." (Rohani, 2017). EDUCATION is our main purpose. We should provide balanced information with pros & cons with the latest references available. Also, if a pilot study is included (Elías, 2013), why excluding the latest randomized clinical trials (Elías, 2016)? YBMPHepi (talk) 03:39, 25 May 2017 (UTC)YBMPHepi

Sources are fine; content is promotional. Bellena i would support whatever you generate from those. We should update the whole article with the more general one - many of the refs used here are old. I would be happy to do implement if you like.Jytdog (talk) 17:16, 25 May 2017 (UTC)

All right, Jytdog. I trust your judgment to rewrite the content. And it would probably be best to move it to the research section. What do you think? I think we have to be more cautious and precise, adjusting to the sources. Efficacy and safety are not yet clear, the improvement is partial and the rates of adverse effects are high, in some cases permantent, with very few studies to date:

Our review has also emphasized the many problems and unknowns related to this novel procedure. It is too early to draw definite conclusions on the value and unsolved issues of MRgFUS, but the good news is that one more option is now available for tremor patients. We believe that a deep understanding of the efficacy and safety of these procedures is needed for the appropriate selection of the surgical patients. Future studies comparing the different treatment modalities are certainly needed.

The results of a randomized trial using either focused ultrasound thalamotomy or a sham procedure in 76 patients have been reported recently (Elias et al. 2016). Patients treated with thalamotomy experienced 50% improvement in tremor rating and this was maintained during the 12-month follow-up period. Side effects of thalamotomy included gait difficulties in 36% of treated patients and paresthesias in 38% of treated patients. They persisted in 9% and 14% of patients, respectively during the 12-month follow-up period (Elias et al. 2016). More long-term follow-up data are needed to establish clearly the role of this method in ET therapy.

Best regards. --BallenaBlanca (Talk) 09:46, 26 May 2017 (UTC)

The focused ultrasound thing is clinical (FDA approved and being used as second line treatment like other surgical approaches), so it doesn't go in research. Right? Jytdog (talk) 18:26, 26 May 2017 (UTC)

Yes, you are right. [1] --BallenaBlanca (Talk) 19:40, 26 May 2017 (UTC)

Jytdog (and other editors), a draft for you to review. Correct what you consider necessary:

Additionally, MRI-guided high intensity focused ultrasound is a non-surgical treatment option for people with essential tremor who have not seen improvement with medication and refused or are not valid candidates for other techniques, such as deep brain stimulation. MRI-guided high intensity focused ultrasound does not achieve healing but can improve the quality of life. However, its safety, efficacy and long-term effects are not yet established. Temporary and permanent adverse side effects have been documented, and also the reappearance of tremors. Possible adverse events include gait difficulties, balance disturbances, paresthesias, headache, hemorrhage in the treated area (which requiries emergency treatment), tissue damage in other areas, skin burns with ulcerations, skin retraction, scars and blood clots. This procedure is contraindicated in pregnant women, persons who have a non-MRI compatible implanted metallic devices, allergy to MR contrast agents, cerebrovascular disease, abnormal bleeding, hemorrhage and/or blood clotting disorders, advanced kidney disease or on dialysis, heart conditions, severe hypertension, ethanol or substance abuse, among others.

Best regards. --BallenaBlanca (Talk) 23:42, 29 May 2017 (UTC)

Any comments? --BallenaBlanca (Talk) 23:06, 11 June 2017 (UTC)

I think the revision proposed is behind the state of the art. Trials have established short term efficacy and likely side effects. The treatment is now clinically available. Research on long-term benefits and side effects is needed. Wcmead3 (talk) 10:56, 28 August 2023 (UTC)

References

Ethanol

I was talking with a man earlier this week who reported that just the smallest amount of Ethanol could quiet his hand tremors significantly. It did not completely suppress them but had a positive effect on their magnitude. He has the autosomal dominant variety as it was common in his family line and is present in a number of family members. 50.53.20.80 (talk) 21:14, 23 June 2017 (UTC)William Bjornson

Thanks for your comment. I searched for reviews on ethanol and I added a brief information [2]. Best regards. --BallenaBlanca (Talk) 11:14, 24 June 2017 (UTC)

NEJM

doi:10.1056/NEJMcp1707928 JFW | T@lk 23:13, 12 May 2018 (UTC)

Deep Brain Stimulation (DBS)

DBS was used to mitigate ET many years before the use of MRgFUS. This treatment approach should have its own section, and should be more extensive than the two fragmented references currently in the article. Wcmead3 (talk) 01:41, 27 August 2023 (UTC)

The new DBS section should include a brief discussion of the effectiveness, side effects and risks of DBS. Wcmead3 (talk) 10:58, 28 August 2023 (UTC)

Recommend shortening the introduction

I'd suggest replacing the statement, "The cause is unknown" with "The mechanism is poorly understood." Then, strike the rest of the Introduction that follows. Wcmead3 (talk) 10:22, 28 August 2023 (UTC)

Aggravating factors

Re. this statement: "Any sort of physical or mental stress tends to make the tremor worse."

There is a better reference for this at a link from ref [2]: https://www.hopkinsmedicine.org/health/conditions-and-diseases/essential-tremor-disorder

Also, a better summary of the factors that make ET worse would be,

"There are various factors that can increase the amplitude of the tremor, such as stress and caffeine." Wcmead3 (talk) 10:41, 28 August 2023 (UTC)

An alternative approach would be to eliminate this statement, since the information is included below in the section entitled Treatment/General Measures. The reference [4] given there could be expanded to [2,4]. Wcmead3 (talk) 10:48, 28 August 2023 (UTC)

Wiki Education assignment: Foundations II

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 June 2024 and 17 August 2024. Further details are available on the course page. Student editor(s): P.Phan!pharmd26, Juupo23, Kris.ram7, Arnavsrastogi (article contribs). Peer reviewers: Perdigaol, Nishka S Patel, Cortizucsf, K.Peralta (Class of '26).

— Assignment last updated by Health Economics and Policy (talk) 19:41, 26 July 2024 (UTC)

Proposed editing plans

. improve and shorten the introduction, add medical citations

. improve the signs and symptoms section

. expand and improve Cause section

. remove the extra genetic section and combine it into the cause section

. review pathophysiology and treatments section and make improvement

. improve diagnosis and research sections.

. add references

. add more images P.Phan!pharmd26 (talk) 21:56, 23 July 2024 (UTC)

Sounds good! Arnavsrastogi (talk) 21:57, 23 July 2024 (UTC)

I'll do the expand and improve cause section and remove extra genetic section and combine into cause section. Arnavsrastogi (talk) 22:00, 23 July 2024 (UTC)

I'll work on the introduction and see if any medical citations could be added. I'll also take a look at the signs and symptoms section. Kris.ram7 (talk) 04:22, 25 July 2024 (UTC)

I added the epidemiology section but forgot to log in and published it. It is currently showing my IP address. Juupo23 (talk) 20:22, 29 July 2024 (UTC)

Foundations II Peer Review

(Summer 2024) K.Peralta (Class of '26) (talk) 22:19, 30 July 2024 (UTC)

Person A (K.Peralta 07/30/2024): The group's edits to the article improve the overall readability of the article, and expand on concepts that are relevant to the subject of essential tremors. The group achieved their overall goals for improvement by adding medical citations to the introduction, keeping it as concise as possible. Their second goal was achieved by adding and expanding information to the Cause section. Although they did not end up combining this section with the Genetics section, the information provided is still relevant to the topic. Their last goals were to make improvements to the pathophysiology, treatments, and diagnosis sections. These improvements were made by explaining specific hypotheses for the pathophysiological mechanism, and then backing up their claims with relevant study evidence. Overall, the article reflected a neutral point of view which successfully presented the information and achieved most of their editing goals. — Preceding unsigned comment added by K.Peralta (Class of '26) (talk • contribs) 22:39, 30 July 2024 (UTC)

Person B (Cortizucsf 07/30/2024): This group significantly improved this article from its previous version. The group did a great job distinguishing this disease state from other common/similarly named disorders. The edits also focused on creating more inclusive wording, lay-language, and a non-pharmacological approaches section. The group also included only reliable sources when citing. I would suggest adding some examples of the medication classes in the non-pharmacological approaches section to provide readers with more context. Additional images of the medications could also help readers see visual context. My final suggestion is to move the Prognosis and Epidemiology sections higher up on the page to give readers more context and background. Overall, this group did a great job improving this article for the public. — Preceding unsigned comment added by Cortizucsf (talk • contribs) 03:48, 31 July 2024 (UTC)

Person C (L.Perdigao 07/30/2024): The group's edits improve the article as described in the Wikipedia's peer review "Guiding Framework". The edits added relevant information with reliable references allowing users to gain a better and deeper understanding of Essential tremors. The addition of images also will allow readers to gain a better understanding of trickier concepts as well, such as DBS. The group has also achieved its overall goals for improvement. Reading through the group's proposed editing plan and then viewing and comparing the group's edits to the previous version, I thought each of the editing goals were efficiently met. The group's edits also ensured that the article meet all Wikipedia guidelines. The Essential Tremor article had all five elements; a lead section that is easy to follow, clear structure, balanced coverage, neutral content, and reliable sources, which is seen throughout all of the best wikipedia articles. Also, I think the addition of the 'Epidemiology' section added even more relevant and useful information about the disorder and was consistent with Wikipedia's Manual of Style. When reading the article and focusing on the organization of the information and comparing the content of the article to the suggestions of sections/content to include from the Manual of Style, I felt all recommended sections were included. — Preceding unsigned comment added by Perdigaol (talk • contribs) 23:38, 30 July 2024 (UTC)

Person D (Nishka S Patel 07/30/2024): I found the article to be greatly detailed and the topics were consistent with each other. However, I did feel that some terms could be simplified into lay language to make it easier for readers. The group did achieve its overall goals for improvement by adding relevant data and multiple references that show the amount of research done on the topic. The talk page also had a plan section where the group members discussed how to improve the article by adding relevant sections and removing confusing sections. The Essential Tremor article had a well-structured "treatment approaches" section which included both pharmacological and non-pharmacological methods in a structured manner. The edits somewhat reflect language that supports diversity, equity, and inclusivity, however terms such as "patients" may seem inappropriate for Wikipedia and should be changed to "people" instead. Overall, they did a great job with editing the article.

Prevalence estimates seem wrong

The below excerpt is confusing:

The prevalence of ET increases significantly with age, particularly in individuals aged 60 and above. It affects around 4% of people aged 40 and older, and the prevalence rises to 2.87% in those over 80, reaching up to 20% in individuals in their 90s and beyond.

If it’s true that prevalence increases with age then the numbers are suspect and should be checked against the sources again. Emjonaitis (talk) 10:37, 23 December 2024 (UTC)