Tremor

We approach tremor by asking what it costs you. A tremor that barely registers on a clinical rating scale can end a dental career. A tremor that looks dramatic from across the room may not trouble the person who has it. We build the plan around your hands, your work, and the things you’ve stopped doing — then we decide together what role medication should play in it.

An Introduction

Roughly 7 million adults in the United States live with essential tremor, and many more have tremor from other causes entirely.

Most people arrive at a neurologist’s office with the same two questions: what is this, and is it going to get worse?

Tremor is one of the conditions where the answer depends heavily on who is doing the looking. Essential tremor is frequently misdiagnosed, most often as Parkinson’s disease or dystonia.

• Tremor has many causes, and identifying the type changes the entire treatment plan.
• Essential tremor is the most common, but it’s frequently confused with Parkinson’s disease and with dystonia.
• Medication helps many people. It manages symptoms rather than altering the underlying condition, and it isn’t the only route.
• Botulinum toxin (Botox), deep brain stimulation, and MR-guided focused ultrasound (HiFU) are all options for the right patient. We evaluate candidacy for each.
• Treated by Dr. Chambers and Dr. Mentreddi, both fellowship-trained in movement disorders.

Our Approach to Tremor

Tremor is a category, not a diagnosis, and the distance between two tremor types can mean two completely different treatment plans.

Sorting that out takes an unhurried exam and a real history, which is difficult to do in a fifteen-minute visit.

It also takes follow-up: the medications used for tremor need careful titration, and we can see you within weeks of a change to find out whether it worked rather than scheduling you out six months and leaving you to wait.

• Fellowship-trained diagnosis. Dr. Chambers and Dr. Mentreddi completed movement disorders fellowships, which means the differential between essential, parkinsonian, dystonic, and functional tremor is routine work rather than an occasional puzzle.
• Built around what you’re trying to do. We ask how the tremor affects your job, your handwriting, your meals, and your confidence in public. A dentist and a retired teacher with identical tremors need different plans, and standard severity scales don’t capture that difference.
  
  Your plan might be daily medication, medication taken only before the situations that matter most, a lifestyle approach, or some combination. Medication for essential tremor eases the shaking without changing the underlying condition, so how large a role it plays is genuinely your call.
• Tools alongside medication. Weighted and stabilizing utensils, adaptive equipment, and technique adjustments can change your daily experience meaningfully. We also handle the paperwork and approval process for assistive devices.
• Stress treated as a clinical variable. Nearly every person with tremor notices it worsens under stress. We work on stress resilience directly as part of the treatment plan, because for some people it produces more improvement than the next medication would.
• Full evaluation of procedural options. For tremor that doesn’t respond adequately to medication, we evaluate candidacy for deep brain stimulation and MR-guided focused ultrasound (also called HiFU), and we do the counseling that helps you weigh them.
  
  For dystonic tremor (dystonia), botulinum toxin injections are placed by our physicians with fellowship training in the injection patterns these cases require. We also program existing DBS devices for patients who already have one.
  

Most people we see for tremor have been told some version of “it’s benign, here’s a prescription, come back in six months.” That may be the right plan. But it should be a plan you chose, after someone confirmed what you actually have and asked what you want back.