Tremors fundamental: Signs, origins, and identification methods
In the realm of neurological disorders, essential tremor (ET) and Parkinson's disease (PD) share a common symptom - tremors. However, these conditions are distinct entities with different underlying mechanisms and progression patterns.
Essential tremor primarily causes trembling during action or postural holding, often affecting both hands and sometimes the head and voice, without stiffness or slowness of movement. On the other hand, Parkinson’s disease presents with resting tremor, muscle stiffness, slowness of movement (bradykinesia), poor balance, and other motor and non-motor symptoms.
While ET is slowly progressive and strongly genetic, Parkinson’s disease progresses more rapidly and has a less clear genetic basis. ET typically affects both sides symmetrically, whereas PD usually starts asymmetrically on one side of the body but can involve both sides as it progresses.
Scientific research has uncovered potential links between these conditions. Some studies have reported a higher occurrence of pathological Lewy bodies (abnormal aggregates of alpha-synuclein protein characteristic of PD) in the brains of some ET patients compared to normal elderly individuals. This suggests a potential biological link or overlap, especially in a subset termed “ET-plus” where ET patients show additional neurological signs.
Recent neuroimaging research using diffusion tensor imaging along the perivascular space (DTI-ALPS index) shows glymphatic system deterioration in PD relative to ET. Glymphatic dysfunction might contribute to the accumulation of Lewy bodies. ET-plus patients exhibited significantly reduced glymphatic function compared to pure ET cases, hinting that ET-plus’s pathophysiology could be related to mechanisms also implicated in PD.
Advances in neuroimaging and biomarkers, such as the Syn-One Test, are improving diagnostic differentiation and understanding of these disorders. In a recent clinical utility study, results from this test led to diagnostic changes in a significant number of patients, especially those with action tremor, shifting diagnoses from ET to PD or vice versa. This test also influenced treatment decisions, such as starting or stopping levodopa.
While ET and PD share tremor symptoms, they differ fundamentally in clinical presentation, progression, and pathology. However, some pathological overlaps (e.g., presence of Lewy bodies in ET patients) and shared dysfunctions (like glymphatic impairment in ET-plus and PD) suggest a potential biological link in subsets of patients. Ongoing scientific research is focused on elucidating these links and developing precise diagnostic and therapeutic strategies.
Better differentiating ET from PD enables more targeted treatment approaches and improves patient outcomes. For instance, a study suggests that physical therapy focusing on balance, functional movement, and stability may help improve walking speed, balance, and performance of daily tasks in people with essential tremor. Another surgical option is a thalamotomy, which involves making a small lesion in the thalamus to block the brain activity causing the tremor.
Despite advancements, it's essential to remember that complications can arise with treatments like deep brain stimulation (DBS) and thalamotomy. Complications of DBS include headache, pain after surgery, seizures, bleeding, and swelling in the brain.
As we continue to unravel the mysteries of ET and PD, it becomes increasingly clear that each condition requires a unique approach to diagnosis, treatment, and management. Understanding these differences is crucial in improving the quality of life for those affected by these disorders.
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