Idiopathic tremor is a common clinical Extracorporeal diseases, which are more common in the elderly, are mostly clinically manifested as involuntary tremors of the limbs when the limbs are still and in motion, resulting in the inability to complete fine movements such as eating and buttoning. Slight tremor of one hand or both hands, so many people do not pay attention to it, but as the amplitude of limb tremor increases, its impact on life is also more and more. Daily movements such as shoelaces seriously hinder the healthy life of the elderly. Today, I will introduce 3 types of drugs. Scientific use can effectively improve limb tremors.

Uncle Wang, who is in his 60s, has recently been troubled by one thing, that is My left hand is always trembling involuntarily.The trembling is not obvious when standing still. Once I go to get a bowl, Shakes violently when holding a water glass, which seriously affects daily activities such as eating and drinking, and even needs the help of my wife to tie the buttons, I later heard that the disease may be Parkinson’s, so I hurried to the hospital for examination. The doctor diagnosed that Uncle Wang was actually an essential tremor, not Parkinson’s, after a systematic examination< /strong>, Uncle Wang had never heard of essential tremor, so he quickly asked if it was serious, The doctor explained that essential tremor is a movement disorder that is prevalent in the elderly. Its manifestations are similar to Parkinson’s, but the prognosis is better than Parkinson’s disease< /strong>, so he prescribed the corresponding medicine to Uncle Wang, instructed him to take it in a standard way, and regularly review it. After taking the medicine, Uncle Wang’s left hand trembled as expected. Much relief and improved quality of life.

Essential tremor is one of the most common movement disorders in adults,Its essence is an extrapyramidal disease, the main clinical manifestations are resting and motion tremors of the hand or head, resulting in the body unable to Complete a variety of fine motor activities, such as eating, drinking, writing, etc.. The elderly are a predisposing group for essential tremor, it occurs in approximately 10% of people over the age of 65 about 1.7% of the general population, so it often causes inconvenience for the elderly and affects the living standard of the elderly. Secondly, many elderly people cannot distinguish between essential tremors and Parkinson’s themselves, so they suspect that they are Parkinson’s as long as there is tremor in their limbs, carry heavy psychological burdens for no reason, and even lead to depression.So scientific understanding and treatment of essential tremor is particularly important for maintaining the health and quality of life of the elderly.

I. Pathogenesis of essential tremor

Before introducing essential tremor, let me introduce a relatively unfamiliar concept, That’s the extrapyramidal system.

The so-called pyramidal system mainly includes the striatal system and the vestibulo-cerebellar system in the central nervous system. The two systems are the main centers and important conduction pathways that govern all our body movements, mainly for regulating muscle tone and coordinating muscle activity. It can be said that the reason why our muscles and bones can move normally and complete the corresponding actions according to our ideas is the function of the extrapyramidal system. Can lead to a series of limb movement disorders.

Essential tremor is a movement caused by pathological changes in the extrapyramidal system Obstructive diseases, according to current clinical studies, essential tremor is mostly related to genetic factors, but it is also closely related to a variety of central system diseases (such as stroke, cerebral hemorrhage, etc.). Its pathogenesis is due to abnormal extrapyramidal conduction function, which leads to abnormal discharge of the central nervous system, which eventually leads to muscle and limb damage. .

Essential tremor is mostly manifested in the upper extremities and head and neck, and very few appear on the lower extremities. In the early stage of the disease, the patient’s symptoms may not be serious, mostly on one side (more common on the left side) of the upper limb in a certain Slight tremors can be induced in postures, such as holding bowls, cups, buttons, etc. Since the initial symptoms have little impact on life, many elderly people do not care.. However, as the disease worsens, the degree of limb shaking will also increase, even when it is stationary span>, a small number of patients even appear at the same timeAbnormalities in speaking and walking, manifested as slurred speech and unsteady walking, leading to the life of the elderly The quality is greatly reduced, and even cannot take care of themselves.

The difference between essential tremor and Parkinson’s disease

Since essential tremor and Parkinson’s disease are both extrapyramidal diseases and are characterized by involuntary limb tremors, many clinically It is easy to be confused with these two diseases.In fact, both of them are very important in pathogenesis, clinical symptoms and clinical prognosis. Big difference.

1. The pathogenesis of the two diseases is different

Although they are all caused by pathological changes in the extrapyramidal system, idiopathic The pathogenesis of tremor and Parkinson’s disease is not the same. The main pathogenesis of essential tremor lies in the abnormal information transmission function of the extrapyramidal system, which leads to the central nervous system’s effect on the muscles. Decreased control, which induces a series of involuntary movements. The main pathogenesis of Parkinson’s disease is the death of dopaminergic neurons in the substantia nigra and the sharp increase in dopamine levels in the striatum. , which induces a series of clinical symptoms, including abnormal performance in many aspects such as emotion and movement. It is precisely because the pathogenesis of the two diseases is different thatthe drug regimens for their clinical treatment are also different , so it must be strictly distinguished clinically.

2. The clinical manifestations of the two diseases are different

Although essential tremor and Parkinson’s disease both have limb stiffness and Involuntary tremors, but both in specific tableThere are obvious differences now, and it must be carefully distinguished clinically.

①Different characteristics of limb tremors strong>

Essential tremor also containsrest tremor and kinematic tremorcharacteristics, and Limb tremors tend to be aggravated during exercise, resulting in inability to complete fine movements.

Parkinson’s disease majorMainly resting tremorThe typical symptoms are Continuous rubbing between thumb and index finger like a pill when stationary, but the tremors lessen or disappear after activity.

②Different locations of limb tremors strong>

Essential tremor mainly in the upper extremities and head and neck< /span>, most patients only present with unilateral or bilateral tremor of the upper extremities, extremelyA few will accumulate to the lower limbs.

Parkinson’s disease mostly occurs in the unilateral upper extremity, But as the disease progresses, it will slowly progress to the opposite side, and even accumulate lower extremity activity, eventually even resulting in obvious obstacles to limb movement.

③Different symptoms associated with the disease

Patients with essential tremor are mostly extremity tremors,Almost no other symptoms, especially no significant hindrance to joint movement, there will be no obvious disabling effect, a few patients will have language or walking disorders, but most of them are mild.

Parkinson’s disease is not just a resting tremor, And it will be accompanied by obvious muscle rigidity, which leads to obvious impairment of joint movement and slow movement of patients,In the later stage, it can accumulate to the muscles of the lower limbs, head and face, etc., resulting in serious movement disorders such as inability to walk, difficulty swallowing, and finally even cause Dyskinesia of the respiratory muscles, thereby inducing respiratory failure. Secondly, Parkinson’s disease can induce a series of non-exercise symptoms such as fatigue, depression, anxiety, sleep disturbance, and cognitive impairment. Symptoms, many patients show mental abnormalities such as insomnia, forgetfulness, depression and anxiety, < spanclass="data-color--tt-darkmode-969696">Essential tremor does not have psychotic manifestations.

3. The prognosis of the two diseases is different

Patients with essential tremor have little or no impact on life except limb tremor. There will be other functional abnormalities, and some patients do not even need treatment and will not significantly affect their lives.So essential tremor is The prognosis is usually better, and the fundamental purpose of treatment is to reduce the impact of limb tremor on the quality of life of the elderly. Parkinson’s disease will gradually increase the number of accumulated tissues and organs with the development of the disease, and eventually lead to abnormal function of multiple limbs and organs, and even lead to respiratory failure in severe cases.So the prognosis for Parkinson’s disease is often poor.

Class 3 and 3 drugs commonly used in the treatment of essential tremor

Drug therapy has always been the first-line treatment for essential tremor in clinical practice. -color–tt-darkmode-969696″>Adrenal beta-blockers, antiepileptics, antidepressants, etc.To treat and relieve essential tremor, often good therapeutic results can be achieved.

1. Adrenal beta-blockers

Adrenoceptor beta-blockers are clinically used in the treatment of idiopathic The first-line drug for tremor, the clinical efficacy shows that the patient’s limb tremor can be effectively improved by blocking beta receptors.The commonly used drugs are Propranolol and arolol.

Propranolol is one of the commonly used drugs for the clinical treatment of essential tremor. Essentially, it is a non-selective blocker, which has obvious blocking effect on β1 and β2 adrenergic receptors, especially it can act on β2 receptors in the central nervous system, thereby enhancing the effect of extrapyramidal system on peripheral Muscle control, reducing abnormal signal transmission, clinical studies have shown that daily oral propranolol 40-120mg can effectively relieve more than 60% of the clinical symptoms of essential tremor patients. However, it should be noted that propranolol can induce sinus bradycardia and hypotension, so monitor blood pressure and Heart rate is contraindicated in patients with previous hypotension, bradycardia, heart failure and other diseases. Secondly, propranolol can induce asthma, so it is contraindicated in patients with allergic rhinitis or asthma.

Arololol is a novel beta-blocker , has a certain blocking effect on β-receptors and α-receptors, and its effect is stronger than propranolol, and has no endogenous sympathomimetic activity, so it is less likely to cause adverse reactions such as hypotension, and its safety is high. to propranolol. Clinical studies have shown that oral 10mg arolol, twice a day, can effectively relieve the clinical symptoms of patients with essential tremor. However, it should be noted that long-term oral administration of arolol can cause palpitations, bradycardia, hypotension, and aggravated heart failure. At the same time, there will be a certain burden on liver and kidney function, so patients with abnormal liver and kidney function should use it with caution; secondly, a small number of patients are allergic to arolol in clinical practice, so we must pay attention to whether there is any allergy such as rash and itching during taking Response.

2. Antiepileptic drugs

The pathogenesis of essential tremor is similar to that of epilepsy, and the underlying causes are both It is caused by abnormal discharge of the central nervous system, so antiepileptic drugs are often used as first-line drugs for the treatment of essential tremor.Among them are primidone and topiramate.

< span class="data-color--tt-darkmode-969696">Primidone is one of the first-choice drugs for the treatment of essential tremor in clinical guidelines, and many clinical studies have shown that it can greatly improve the prognosis of patients with essential tremor. Vibration amplitude, improve voice tremor. As an antiepileptic drug, primidone can significantly promote the development of chloride ion channels on the surface of nerve cells, thereby reducing the excitatory effect of glutamate in the central nervous system and enhancing the inhibitory effect of γ-aminobutyric acid , reducing the abnormal discharge of the central nervous system, thereby effectively reducing the abnormal activity of the limbs.But it should be noted that oral primidone will A series of adverse reactions such as dizziness, drowsiness, nausea and vomiting occur, and a small number of patients may even experience damage to the hematopoietic system, resulting in leukopenia, thrombocytopenia and other adverse reactions, so it is often used clinically with folic acid tablets to reduce adverse reactions. Secondly, A small number of patients can not tolerate the effect of primidone, resulting in serious toxic reactions, such as liver and kidney function damage, lethargy, personality changes, etc. If the above serious adverse reactions occur, it is recommended to replace other drugs immediately< span class="data-color--tt-darkmode-969696">.

Topiramate is a new type of antiepileptic drug. Its main mechanism of action is to block the sodium channel on the surface of nerve cells, increase the concentration of high γ-aminobutyric acid, and activate the frequency of γ-aminobutyric acid receptors, which can inhibit the The production and transmission of excitatory neurotransmitters, thereby reducing the excitability of the central nervous system. Clinical studies have shown that topiramate can effectively improve limb movement and reduce tremor in patients with essential tremor.But it should be noted that topiramate easily induces adverse reactions in the central system, such as ataxia, impaired attention, confusion, dizziness, fatigue, etc., and can also lead to anxiety, forgetfulness, aphasia, depression, emotional instability Other emotional abnormalities.

3. Antidepressants

Anti-depressants are second-line drugs for clinical treatment of essential tremor. Antidepressants are helpful in relieving essential tremor,alprazolam >.

Alprazolam is a new type of benzodiazepine that inhibits brain The β-adrenergic receptors in alprazolam have obvious anti-anxiety and anti-depressant effects, as well as obvious anti-convulsant and muscle-relaxing effects. Clinical studies have shown that alprazolam can significantly relieve the clinical symptoms of essential tremor, so Often used as a second-line drug. But it should be noted that long-term use of alprazolam will lead to drug dependence and addiction, so long-term use is not recommended ; Secondly, it is contraindicated for patients with sleep apnea, severe liver and kidney insufficiency, glaucoma and other diseases.

Four. Summary

As one of the common diseases of the elderly, essential tremor has a huge impact on the quality of life of the elderly. Therefore, it is clinically recommended to carry out standardized drug treatment as soon as possible to alleviate the disease, delay the development of the disease, and improve the quality of life of the elderly. The quality of life of the elderly, but the drugs for the treatment of essential tremor often have more side effects, so it must be used under the guidance of a doctor. Secondly, drug treatment is only a part of the prevention and treatment of essential tremor. Elderly people with essential tremor should improve their living habits, eat a balanced diet, supplement the necessary nutrition, maintain a good sleep, and strengthen their physical fitness. Fundamentally prevent essential tremor.

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