Rehabilitation in Essential Tremor

Abstract

Essential tremor (ET) is the most common movement disorder with the main clinical features being postural and kinetic tremor in the upper limbs with or without head and voice tremor. Gait ataxia and balance issues may occur as well. Recently, nonmotor symptoms have also been hypothesized to be part of this condition, including cognitive deficits, depression, anxiety, hearing impairment, olfactory dysfunction, and sleep problems. The motor aspects of ET are invariably progressive and may lead to significant impairment in functionality and quality of life. ET therapy includes pharmacological, nonpharmacological, and surgical approaches. First-line pharmacotherapy includes propranolol and primidone, which contribute to symptoms relief; however, potential side effects particularly in elderly patients limit their use. Surgical approaches such as deep brain stimulation (thalamus and posterior subthalamic area) and thalamotomy are also useful, although they have more specific indications and potential side effects. Currently, novel nonpharmacological therapies are in the pipeline for ET treatment, including physiotherapy and rehabilitation, aiming to explore new ways of assisting patients and improving functionality. Resistance training, inertial loading, dexterity training, transcutaneous electrical nerve stimulation, and massage have been proposed and investigated as potential means of rehabilitation in ET. The current chapter summarizes the clinical features of ET and current therapies, focusing on nonpharmacological approaches.