How Do You Treat Essential Tremor in Your Practice?

Essential tremor is considered to be the most-common movement disorder in the world. The treatment for patients with essential tremor remains a therapeutic challenge.¹ It is the most-common cause of a pathologic tremor, as an isolated tremor syndrome, without other neurologic symptoms. This condition presents with an action tremor of the bilateral upper limbs, of at least 3 years duration, with or without involvement of the head, lower limbs, and voice.² The biomedical treatment for essential tremor is pharmacotherapy with propranolol or primidone; however, the pharmacotherapy reduces essential-tremor severity by only half,³ therefore, alternative forms of therapy need to be considered, such as acupuncture, tui-na, and herbal medications.

Traditional Chinese Medicine (TCM) differential diagnostics explains that, essential tremor is due to Stagnation of Liver Qi with Yang Excess expressing as Liver Wind. The condition also arises from Deficiencies of the Spleen and Kidneys. Acupuncture has been shown to have therapeutic outcomes, reducing or eliminating the clinical effects of essential tremor, and maintaining and improving patients' quality of life.⁴

Illustrative Case

A 63-year-old female, had a tremors in both hands, a jaw tremor upon action, and pain and swelling in her right knee and right ankle. She had a red tongue without a coating, and a tight and rapid pulse. Her past history included a myocardial infarction and hypertension for the past 10 years. She was taking antihypertensive and antiplatelet medications.

The application of primary acupuncture points was in the anterior and parietal areas of the scalp at Baihui (GV 20) and Sishencong (EX-HN1). The body acupoints treated with perpendicular insertions of needle at Fengchi (GB 20), Taiyang (EX-HN5), Quchi (LI 11), Waiguan (TB 5), Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6), and Taichong (LR3). These acupoints were selected based on the acupuncture point selections according to TCM meridian theory to treat essential tremor. Acupuncture was applied with a 0.3 × 45–mm stainless-steel needle (Hansol Medical Co., Korea). The needles were inserted into the muscle layer, especially at Baihui. These needles were inserted perpendicularly and twirled slightly. They were retained for 40 minutes. This treatment was administered 4 times per week.

This patient's severity of tremor was decreased by 30% on the 15th day after treatment, by 70% on the 30th day after treatment, and by 90% on the 40th day after treatment. After her acupuncture treatments, she experienced slight tremors that occurred when she had anxiety and stress intermittently. The treatment was finished without worsening her tremor symptoms. No severe acupuncture side-effects were noted.

Conclusions

Essential tremor is one of the most-common movement disorders encountered in clinical practice. The current patient's tremors were reduced drastically after acupuncture treatment. Some case studies have shown the successful treatment of essential tremor, wherein patients continued to maintain these clinical benefits through monthly acupuncture sessions at 12 months after initial acupuncture treatments.^5,6 A systematic review by Shin et al. suggested that treatment of essential tremor with TCM may be more effective and safe than Western medicine.⁷

Future clinical studies should have large sample sizes, and be strictly designed randomized controlled trials, that use unified acupuncture point selections according to the Consolidated Standards of Reporting Trials [CONSORT] and Standards for Reporting Interventions in Clinical Trials of Acupuncture [STRICTA]guidelines. Such rigorous trials are needed urgently to prevent heterogeneity and produce high-quality evidence-based clinical research.