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Intentional Tremor.

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Hello, I'm a 36yo male and have noticed a tremor in my neck over the past 3 years. It seems to get worse with stress or caffeine. I think there has been history of this ailment in my family. Have been to a family practice diagnosed as a benign nonessential tremor. I was referred to a neurologist and tried several different medications but the side-effects have more debilitating than the original diagnosis also with limited success. Are there any types of soft tissue scans that could be used to help locat and correct the problem with the nerves as opposed to treating the symptoms? Also if there aren't are there any good natural supplements that could help other than alcohol?

Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.


Thank you for choosing DoctorSpring

I would like to know some additional details from you so that I can provide a solid and learned opinion.
You can reply as a followup.

1. Is the tremor limited only to neck ? (or also in arms and limbs) If so is it kind of a neck nodding ?
2. Does alcohol reduces it dramatically ?
3. When is the tremor more prominent ? - While at rest or while doing some activities ?

Thank you

Patient replied :

It's only in the back part my neck and causes my head to shake from side to side. No other limbs seem to be affected. Also noticed stiffness in one place between the dorsal occipital and cervical region. Have tried different stretches, rotations to loosen the muscles but this only helps temporarily. Alcohol stops the tremor completely but can't drive or work while using. The tremor has been constant while resting or during activities but seems to get worse with stress, caffeine, or when trying to rotate head to the left.

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.


I discussed your case with your team Neurologist. The tremor is most likely to be essential tremor. I understand that this could be really frustrating for you, but as of now we have not found out the real cause behind this tremor. This makes your concept of attacking the root cause rather than symptoms difficult. In case of essential tremor the approach IS to treat the symptoms and there is nothing wrong in this approach.

The choice of treatment is a trial and error approach. Propranolol and primidone are usually the most successfully used medications. Let me know what medications you have tried. Extreme options are Thalamotomy and Deep Brain stimulation. Botulinum toxin is a option, but it is well studies in case of limb tremors.

Regarding alternatives, supplements - there aren't any PROVEN options or alternatives. I just do not want to misguide you on this. Your best shot would be to have a treatment approach with medications - if not Botulinum toxin.

Hope this helps
Feel free to ask followups
Thank you

Dr. Deepu Sebin Sebastian
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MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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