Treats head tremors with CBD oil
Essential tremor: what therapy options are there?
Everyone has a physiological tremor. This manifests itself in the form of a slight tremor. However, this normal tremor is not noticeable because it is far too weak. The essential tremor, on the other hand, manifests itself in the form of a rhythmic tremor when performing a voluntary movement or when holding a position against gravity. A distinction is made between the two main types of tremor:
- Action tremor: Action tremor occurs when, for example, a glass is brought to the mouth or liquid is poured into a glass with a water bottle. In the rest state, however, there is no trembling.
- Posture tremor: This is where tremors appear when, for example, an arm is stretched out and held against gravity.
Most people suffer from both types of tremor. The tremor can affect different areas of the body, with an essential tremor most commonly occurring in the head (head shaking tremor) and in the hands. But other parts of the body such as the vocal cords or legs can also be affected.
How strong the tremor (amplitude) and how fast the frequency is can vary from patient to patient. As a rule, the frequency decreases with advancing age and the amplitude increases. The course of the disease is progressive. That is, it is a chronic condition that continues to progress. A cure is not yet possible.
Some patients experience symptom-free periods, while other people suffer from it for their entire life. Still others experience increasingly increasing symptoms. The course of the disease is therefore not the same for every person affected. However, it is known that emotional factors such as stress or excitement can make symptoms worse.
How does an essential tremor arise?
It has not yet been fully understood why a tremor develops.
The causes have not yet been clarified. It is believed that around 60 percent of cases of the disease are due to genetic causes. Scientists believe that chromosomes 2, 3, and 6 are involved and that if only one gene is defective, the disease breaks out.
However, the essential tremor can also occur without the genetic material showing any changes.
It is considered certain that the symptoms of tremor arise from the fact that communication between different brain areas such as the thalamus, the brain stem and the cerebellum is disturbed. These neuronal malfunctions usually only develop between the ages of 20 and 60. Children are rarely affected.
Diagnosis and exclusion of other diseases
The diagnosis is about excluding other diseases and causes (exclusion diagnosis). These include the following diseases:
- Parkinson's disease: Parkinson's patients usually have a resting tremor. Parkinson's tremor only begins when, for example, the hand is resting on the lap (tremor at rest). Movement usually improves the tremor. Parkinson's disease is caused by damaged switching points in the brain, which leads to tremors and movement disorders. A main symptom of the disease is akinesia (immobility).
- Dystonia: If there is dystonia, those affected tend to have poor posture, which heralds a dystonic tremor.
- Hyperthyroidism: The thyroid gland produces too many hormones in the case of an overactive thyroid (hyperthyroidism), so that, among other things, it leads to psychomotor restlessness. The tremor often occurs here in the fingers.
- Graves Disease: This autoimmune disease affects the thyroid gland. This leads to an overactive thyroid, which can be accompanied by tremors.
- Multiple sclerosis (MS): Some people with MS develop tremor (cerebellar tremor).
- Alzheimer's disease: The death of the nerve cells in the brain not only leads to memory loss and the loss of the ability to think, but also to motor disorders such as tremor.
- Wilson's disease: If the copper metabolism in the liver is disturbed, more copper is deposited in the brain, which leads to functional disorders in the liver and tremors (tremors). The copper deposits can also lead to life-threatening cirrhosis or inflammation of the liver.
- Guillain-Barre syndrome: Orthostatic tremor can occur in Guillain-Barre syndrome. The orthostatic tremor also shows itself in a head trauma.
Other causes can be:
- Liver failure: When the liver fails, toxic metabolic products accumulate in the body, which can lead to motor and neurological disorders, among other things. Tremor can be a sign of liver failure.
- Diseases / disorders of the peripheral nervous system: Disorders in the peripheral nervous system can be triggered, for example, by a polyneuropathy. Here, too, tremors or muscle tremors can occur.
- Encephalitis: If nerve cells in the brain are damaged as part of an inflammation of the brain, for example as a result of a TBE or measles infection, a tremor can also occur here.
- Damage to the brain: The Holmes tremor can be due to damage to the brain stem or the cerebellum. It is a rest, holding and intention tremor.
- Mental illness: A psychogenic tremor can occur when an emotional overload occurs or there is muscular tension.
Side effects of drugs as a cause
In addition, certain medications can cause essential tremor as a side effect. Above all, this includes antidepressants, which are used to treat depression, anxiety disorders and panic attacks. The same applies to neuroleptics that are used in psychoses.
A comprehensive neurological examination should be performed to rule out other disorders.
Essential Tremor - Which Doctor?
The symptoms fall into the specialist field of neurology. To make the diagnosis, the neurologist will perform the following examinations:
- Anamnesis interview / recording of the medical history
- neurological examination of nerve functions
- Review of reflexes and coordination skills
- Electromyography (EMG) to determine the tremor frequency
- Blood test to check liver, kidney and thyroid values
- Urine test (determination of copper content)
In individual cases it may also be necessary to perform an electroencephalography (EEG), a skull computed tomography (CT) or a magnetic resonance tomography. If Parkinson's or Alzheimer's disease is suspected, an examination of the cerebrospinal fluid is also required.
Therapy and Treatment
Targeted treatment is difficult because the causes have still not been adequately researched. Whether drug therapy is even an option depends primarily on the tremor patient and his or her level of suffering.
The active ingredient propranolol (beta blocker), which is normally used for high blood pressure, is usually prescribed as the first drug of choice. Scientists at the Christian Albrechts University in Kiel state that the strength only decreases by about 50 percent when a beta blocker is given.
Also not to be despised are the considerable side effects of the beta blocker, such as headaches, cardiac weakness reinforcement, nausea and vomiting, abnormal sensations, sleep disorders and nightmares up to depression and hallucinations. In men there is even a risk of erectile impotence.
Use of anti-epileptic drugs
The second most commonly used drug is the anti-epileptic primidone. But for this drug, too, the German researchers state that only a reduction in tremor of around 50 percent can be expected. Primidone is used against epilepsy and here too, severe side effects are to be expected, including the following:
- a headache
- Double vision, trembling eyes, fixed gaze
- Lethargy and fatigue
- Disturbances in perception and consciousness
- Speech disorders, memory and thinking disorders
- short-term memory loss
- extended response time
Another anti-epileptic drug is topiramate. Researchers at Baylor College of Medicine in Houston conducted a placebo-controlled study on 208 subjects who suffered from involuntary, rhythmic, trembling movements of a body part. The results say that tremor symptoms only improved by 29 percent after 24 weeks of treatment with topiramate. In addition, 32 percent of the subjects stopped participating in the study due to undesirable side effects.
The anticonvulsants pregabalin and gabapentin, which are used against epilepsy, anxiety disorder and neuropathic pain, are also not sufficiently effective in treating tremors. This is confirmed by a study carried out by the University of Catania in Italy in 2016.
Use of benzodiazepines
In addition, the aforementioned drugs are also often combined with benzodiazepines such as alprazolam or clonazepam. So far, however, the current study situation is insufficient to assess the effectiveness and safety of these drugs, which are not exactly low in side effects. In addition, benzodiazepines are not suitable for long-term use because they have a high potential for dependence.
In fact, small amounts of alcohol can lead to a short-term improvement in symptoms. As a rule, however, the symptoms of tremor worsen in the following days. That alone shows that alcohol is not a permanent solution. In addition, even with the regular consumption of small amounts of alcohol, there is an increased risk of alcohol dependence.
How effective is high frequency stimulation (deep brain stimulation)?
If those affected are severely affected by the tremor symptoms, high-frequency stimulation (deep brain stimulation - DBS) of the nucleus ventralis intermedius (VIM) of the thalamus may be an option. As part of an operation, two small holes are drilled in the skull. Electrodes are then placed in the VIM using thin wires, which transmit electrical impulses. This is intended to disrupt rhythmic vibrations. Research has shown that stimulation can reduce symptoms by up to 80 percent. However, the potential benefits and risks of deep brain stimulation should be weighed carefully before attempting such intervention in the brain.
In addition to conventional therapy, homeopathic treatment methods are also available. In homeopathy, poisonous plants are usually used against movement disorders or nerve disorders.
These include Agaricus from the poisonous fly agaric, which is used to treat muscle tremors. You can also choose from yellow jasmine (Gelsemium) or wormwood (Absinthium), which have an effect on the central nervous system. However, such therapy should always be carried out under the guidance of an experienced alternative practitioner.
In addition, some plants are known in herbal medicine that can act on the nervous system. Herbal medicines against tremor symptoms are made from passion flower, lemon balm, lady's slipper, valerian and mistletoe and can have a positive effect on involuntary rhythmic movement. However, usually only minimal improvements are noticeable with this.
Cannabis-based drugs can be an alternative with few side effects.
Therapy with medicinal cannabis
The IACM (International Working Group on Cannabis as Medicine) names many studies for the therapeutic relevance of medicinal cannabis, in which it could be shown that the cannabinoids from the hemp plant such as THC and CBD can positively influence the symptoms of tremor.
As early as 1986 it was shown that the non-psychoactive cannabidiol (CBD) can be useful in the treatment of movement disorders. The study reported one patient with essential tremor and one patient with dystonia. Both patients received 200 milligrams of CBD orally and reported a significant improvement in symptoms.
Researchers at the Kerman University of Medical Sciences in Iran found that the endocannabinoid system with its cannabinoid receptors CB1 and CB2 has an impact on motor functions. It is therefore assumed that the cannabinoids from the Cannabis Sativa plant such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which attach to the cannabinoid receptors, could have a positive effect.
Cannabis for medical purposes: Current research is still pending
Targeted studies on the treatment of essential tremor with medical cannabis are currently still pending. However, many studies show that the symptoms of tremor could be improved by using cannabis as a medicine.
The GABA and glutamate system play an important role in the transmission of dampening and stimulating stimuli. Various psychotropic drugs such as benzodiazepines (e.g. Valium) also work through this system. Valium molecules occupy the same receptors as the transmitter gamma-aminobutyric acid (GABA), which reinforces their effectiveness.
It is known that there is an excess of glutamate and acetylcholine in diseases such as Parkinson's disease. As a result, dyskinesias such as tremor occur. An oversupply of glutamate can also be observed in alcoholics in the withdrawal phase. Cannabinoids from the hemp plant such as THC and CBD, which are active on the CB1 and CB2 receptors, can reduce this glutamate excess.
In 2000, researchers at University College London were able to use animal models of multiple sclerosis to show that high levels of THC could improve tremor. Tel Aviv University also reported in 2014 on its observational study on 22 patients with Parkinson's who suffered from severe tremor, among other things. A significant improvement in the symptoms of tremor, bradykinesia and stiffness was found through cannabis use with THC and CBD.
More about multiple sclerosis and medicinal cannabis.
The Kermanshah University of Medical Sciences in Iran examined the clinical evidence for medicinal medicinal plants related to MS symptoms such as tremor, spasticity, urination, incontinence and other ailments. Clinical studies from 1966 to 2017 were used for this purpose. The result is that cannabis has the highest clinical evidence and is effective for MS symptoms.
Essential tremor: Further studies of cannabis as a medicine are imperative
The essential tremor is basically not a disease in the strict sense, but just a symptom. Nevertheless, many sufferers suffer and are looking for an adequate solution. Beta blockers, anticonvulsants and benzodiazepines are anything but low in side effects and it is questionable whether these should be accepted in order to put an end to the tremors - although this also does not allow a 100 percent improvement.
Cannabis as medicine would be a gentler alternative with fewer side effects to provide relief for those affected. And that is exactly why it is so important that further investigations are carried out.
Note: In this article we report on prescription CBD or cannabidiol. This article makes no suggestion as to the possible purpose. Promises of use are left to the pharmacists.
- Department of Neurology, Christian-Albrechts-University Kiel, University-Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 10, 24105, Kiel, Germany, Schneider SA1, Deutschl G., 2014, "The treatment of tremor"
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Lotan I1 et al., 2014, “Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study”
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