Treatment and Management

Treatment of intention tremor is very difficult, the tremor might disappear for a while after a treatment has been administered, then return after some time and must be addressed with a different type of treatment. First patients will be asked if they use any of the drugs known to cause tremors, asked to stop taking the medication, and evaluated after some time to determine if the medication was related to the onset of the tremor. A few common drugs that cause intention tremor may be Alcohol, Anti-arrhythmic drugs, anti-epileptic or Anticonvulsant agents, Benzodiazepine, Cyclosporine, Lithium, Neuroleptics, and Stimulants. ^[1] If the tremor persists, treatment that follows may include drug therapy, lifestyle changes, and more invasive forms of treatment such as surgical and other invasive forms of treatment such as thalamic deep brain stimulation. ^[2]

Intention tremor is notoriously known to be very difficult to treat with Pharmacotherapy and Drugs. Although there is no established pharmacological treatment for intention tremor, a few drugs have been found to have positive effects on intention tremor and seen as treatment by many health professionals. Isoniazid, Buspirone hydrochloride, Glutethimide, Carbamazepine, Clonazepam, Buspirone, Topiramate, Zofran, Propranolol and Primidone have all seen moderate results in treating intention tremor and can be prescribed as treatment. Isoniazid inhibits gama-aminobutyric acid-aminotransferase, which the first step in enzymatic breakdown of GABA, thus increasing GABA, the major inhibitory Neurotransmitter in the central nervous system, causing a reduction in cerebellar ataxias. Another neurotransmitter targeted by drugs that have been found to treat intention tremor is Serotonin. The agonist Buspirone hydrochloride, which decreases serotonin's function in the central nervous system has seen as a positive treatment of intention tremor. ^[3]

Alternative treatments include Cannabis, which has been seen as an effective treatment of tremors in patients with tremors. ^[4] [1], Zajicek JP, Apostu VI, "Role of cannabinoids in multiple sclerosis", CNS Drugs. 2011 Mar 1;25(3):187-201. doi: 10.2165/11539000-000000000-00000. </ref> Physical therapy has found great results in reducing tremors among patients, but usually does not entirely cure the tremors. Relaxation techniques such as Meditation, Yoga, Hypnosis, and Biofeedback are other alternative treatments that has seen some results in tremor patients. An at home remedy is wearing wrist weights, which will weigh down one's hands as they make movements, masking much of the tremor. This is not a true treatment, since wearing the weights has not been found to have any lasting effects when they are not on, however they are a quick fix for the tremor, to help the patient cope with the tremor immediately. ^[5]

A more radical treatment that is used in patients who do not respond to drug therapy, physical therapy, or any other treatments listed above and have moderately to severely debilitating intention tremor might look at surgical intervention as treatment. Deep brain stimulation and surgical lesioning of the Thalamic nuclei has been found to be an effective long-term treatment if intention tremor. Deep brain stimulation treats intention tremor, but does not help related diseases or disorders such as Dyssynergia and Dysmetria. Cite error: The <ref> tag has too many names (see the help page). Deep brain stimulation involves the implantation of a device called a brain pacemaker. This medical device with sent electrical impulses to specific parts of the brain changing brain activity in a controlled manner. In the case of intention tremor the thalamic nuclei is the region of the brain targeted for treatment. This form of treatment causes reversible changes and does not cause any permanent lesion, thus is fairly safe, and reduction in tremor amplitude is almost guaranteed and sometimes even resolved with this treatment. Some multiple sclerosis patients have seen sustained benefits in MS progress. Cite error: The <ref> tag has too many names (see the help page). Thalamotomy is a surgical treatment of intention tremor, where lesions of the thalamus nucleus are created to disrupt the tremor circuit. Thalamotomy has been used to treat many different forms of intention tremor including tremors that arise from trauma, multiple sclerosis, stroke, and those whose cause it unknown. This is a very invasive, high-risk treatment with many negative effects such as multiple sclerosis worsening, cognitive dysfunction, worsening of Dysarthria and Dysphagia. Immediate positive effects are seen in patients treated with Thalamotomy, however the intention tremor often comes back after some time, thus no completely treated. Thalamotomy is currently in clinical trials to determine the validity of the treatment in intention tremor with all its high risks. ^[3] Cite error: The <ref> tag has too many names (see the help page).

Related Diseases and Disorders

Intention tremor very common among Multiple sclerosis patients, Ataxia, lack of coordination of muscle movements, which is a major symptom of multiple sclerosis caused cerebellar lesions have been seen intern as underlying causes of intention tremor in multiple sclerosis patients. Multiple sclerosis is a devastating neurological disease caused by demyelination and scarring on the axon of neurons, reducing the ability of the nerve cells of the central nervous system to communicate with each other Almost any neurological symptom can appear from multiple sclerosis, often the disease destroys physical and cognitive function of individuals. Intention tremor can be a first sign of multiple sclerosis in patients, since loss or deteriorated motor function and sensitivity are often the first symptoms of multiple sclerosis. ^[3] Cite error: The <ref> tag has too many names (see the help page). [2] Deuschl G, Wenzelburger R, Löffler K, Raethjen J, Stolze H, "Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor", Brain. 2000 Aug;123 ( Pt 8):1568-80 </ref>

Parkinson's disease has also been related to intention tremor, however usually Parkinson's disease is classified by a tremor that occurs at rest. ^[6] Thus intention tremor is not the classical tremor of the disease, however one that patients might exhibit in addition to the resting tremor. Wilson's disease a disease characterized by resting, postural, or kinetic tremor, so once again not directly related to intention tremor, thus a additional tremor of this disease. Other diseases whose patients will exhibit intention tremor are Creutzfeldt-Jacob disease, Paraneoplastic syndrome, Guillain–Barré syndrome, Endocrinology, Hyperthyroidism, Hypoparathyroidism, and Hypoglycemia (insulinoma). Infections such as Rubella, H. Influenza, Rabies, and Varicella have been correlated to intention tremor. ^[3]

Intention tremor often indicated some fundamental damage to Cerebellum, since the cerebellum is the region of the brain related to fine motor control and voluntary movement. Any sort of cerebral damage can have tragic effects on motor movements because Cerebellum is so integral to fine motor control. Brainstem Tumor, Traumatic brain injury, Vitamin E deficiency, Hypoxia, Cerebellar neoplasm, Hyperthermia or Stroke that occurs in the cerebellum may be underlying conditions to intention tremor. Chronic Alcoholism and overuse of Sedatives or Anticonvulsants have harmful effects on the cerebellum especially degeneration, which can cause permanent damage and are often related to intention tremor. Cite error: The <ref> tag has too many names (see the help page). ^[1]

Intention tremor is frequently accompanied by Dysarthria (a speech disorder characterized by poor articulation and slurred speech), Nystagmus (rapid involuntary eye movement, especially rolling of the eyes), Gait problems (problems and abnormal Walking), and postural tremor or titubation, to-and-fro movements of the neck and trunk. Holmes tremor, a rubral or midbrain tremor is a severe form of intention tremor that affects the proximal muscles of the head, shoulders, and neck. Tremors of this disease occur at frequencies of 2-4 Hz or more. ^[3] Cite error: The <ref> tag has too many names (see the help page).