ESSENTIAL TREMORS

• Hyperkinetic movement disorder characterized by the presence of a variety of different involuntary movements. It can affect any part of the body and occurs often in the hands , but the head, voice, tongue, legs and trunk may also be involved
• Most common involuntary movement disorder with bimodal distribution ;in teens and 6^th decade of life (commonly in elder patients )
• Essential tremor is also sometimes called benign essential tremor. It is the most common type of tremor

• Not known
• 50% with positive family history — autosomal dominant pattern of inheritance
• Can also occur with other neurological conditions, including dystonia, parkinsonism, and certain inherited conditions
• Other causes of tremors include hyperthyroidism, alcohol abuse, poisoning etc.

• Predominantly affects upper extremities
• Most prominent when trying to maintain a posture (postural) or perform an action like touching the finger to an object (kinetic)
• Typically, bilateral and symmetric but one side can be predominantly affected
• Although the tremor may be mild and non progressive in some people, in others the tremor is slowly progressive, starting on one side of the body, but affecting both sides within years
• Most often it affects the hand, but the head , voice, tongue , legs and trunk may also be involved
• Head tremor may be seen as a lateral (side to side) or forward motion
• Mild gait disturbance can also accompany essential tremors

Differential diagnosis

• Parkinsonism - absence of resting tremor, bradykinesia, rigidity, micrographia, other parkinsonian features

• MRI- To exclude structural and inflammatory lesions
• Thyroid function test
• CBC, kidney function
• Neurological examination – Gait, posture & coordination , tendon reflex, muscle strength, tone

Supportive care -Monitoring for changes or improvement

Internal Medicines

• Danadanayanadi kashaya
• Bhadradarvadi kashaya
• Aswagandha choorna
• Brihat vatachintamani rasa
• Rasna dashamoola ghrita
• Sahacharadi taila
• Varuni taila
• Kalyanaka ghrita
• Kooshmanda rasayana

Procedures

• Talam - Rasnadi and Nimbamrita eranda
• Nasya – Rasna dashamoola ghrita / Sahacharadi taila
• Siro vasti – Ksherabala /Dhanwantara taila