How will you feel as a surgeon if you become involved in an accident that takes away your hand, the hand that holds your scalpel? How will you feel if, as a singer, you lose your major instrument which is your voice? How will you feel as an athlete, if you lose your legs a day to the Olympics? Devastated, you may say, in these three scenarios. The same applies to many with a condition known as tremors. They feel hopeless, almost helpless, shattered, overwhelmed because this condition becomes an unexpected, unwanted visitor, bringing changes to their lives. To understand how they feel and what having tremors involves, carefully follow along in your mind’s eye as I tell the true life story of one of the ten million people living with tremors in America: Brad Ackerman
Brad Ackerman inherited tremors from his parents, and this was expected even by him because he had seen it in his uncles and cousins. In fact, because it was something so common to his family, he thought having it was normal. What Brad did not expect was the blow that having tremors would hit him with, he did not imagine that his life would be drastically affected. At first, he learnt to use utensils in a way that damage would not be cause while trying to do little things. Because his both hands were affected by tremors, he had to use both hands interchangeably while trying to hold things because one hand could not handle holding things on its own.
Things became more difficult for him when he wanted to make a career out of drawing because that was where his passion lied. Because of his tremors, he could not hold a pencil and other writing materials well without losing his grip nor could he draw as much and as well as he wanted to. The only thing he could do was making a quick sketch of a work before losing his grip on his drawing and painting materials. As if this was not bad enough for him, his social life; how he acted around others, what he could do in public and what he could not to avoid drawing attention to himself became a matter of concern to him. He started to worry and get anxious about how others viewed him and stressed himself over how to act like other people, like people without tremors, how to live a ‘normal’ life.
As he grew older, his condition worsened. Seemingly simple tasks such as eating, planning surprises for his wife and trying to help her do things became much more difficult for him. On his wedding day, he wanted to make the day as normal as possible, so in front of hundreds of people, he had to struggle to light candles. This also took a toll on his wife as he could not help her as much and as she watched him struggle to get pass each day. Sketching as a designer became more difficult, even with the aid of a computer. The worse part of it was that taking medications made him less productive and after some time, he could no longer do his designing work. His livelihood was taken away from him by this unwanted guest. Saying things became distressing for him was an understatement.
Tremors, often mistaken for nervousness, cold, anxiety is a neurological movement disorder that causes the hands and perhaps other parts of the body to shake uncontrollably. It occurs spontaneously for some. For others, it occurs because it is triggered by other actions. It is caused by incorrect communication in the brain between the thalamus and other parts of the brain. The thalamus is a part of the brain that controls muscular movements and coordination. Normally, it is not life threatening, but if severe, it can limit the victim’s ability to do things on his/her own. At the point of making the victim dependent on others, it becomes a disability.
Tremors are not limited to a particular age group, they can happen to anyone at any age. It occurs mostly to adolescents and middle aged people. The age of a person affects the severity of tremors. Heredity is another big factor in tremors. Children with parents that have tremors have greater risk of inheriting the condition, but people with parents that have no traces of having tremors can also have tremors. Tremors are not intentional, they cannot be controlled by the person to whom it is happening. A man named Tim with tremors for over fifty years says that having tremors is like being in a prison. Of course, someone in a prison cannot come out of his own volition, so what he means is that tremors cannot be controlled by its recipient.
For some individuals, the tremors come and goes. For others, it is constant. For some, tremors go away on their own. For others, treatments are needed. There are different types of tremors, and the most common is essential tremors. Tremors can either be resting tremors or action tremors. The difference is in their names: action tremors occur during movement of the body part when carrying out day to day activities, while resting tremors occurs during rest, when one is lying still; once there is movement, the tremor goes away. The majority of people with tremors have action tremors. Resting tremors affect only the hands, while action tremors can affect any part of the human body.
Sometimes, tremors can be as a result of other actions or reasons apart from the problem in the thalamus. It can be because of stroke, psychiatric conditions, medications, hyperthyroidism, excessive alcohol use, or failure of some body organs. The symptoms of tremors are obvious to the human eyes. They include shaking of the voice, hands, legs and other body parts; difficulty in writing and holding utensils. In some case though, tremors occur as a result of an underlying illness, in which treatment is required, not of tremors but of the underlying illness.
For some forms of tremors, there is no cure. For these, management is the focus. For some though, treatments is very much possible and available. For management, therapy is necessary. It can be physiotherapy which helps to improve muscle condition, coordination and control or occupational therapy which helps the patient adapt to living with tremors. In cases such as tremors from alcohol use, cutting off alcohol or other similar triggers is the best solution to cure tremors. Heavier writing materials and utensils can be made available to ensure better muscle coordination while writing or handling day to day activities.
If all the above are not the needed treatments and management for someone with tremors, medications will be prescribed, depending on how a person reacts to such medication. It is also very important to consider the type or cause of someone’s tremors. If medications do not work for a person and the person’s condition becomes too severe and beyond the power of medications, surgery might be needed. DBS [Deep Brain Stimulation] is one very common surgery for people with tremors. The patient, in most cases have to be awake during the surgery so that he/she can check from time to time with the surgeon if the tremors have stopped. There have also been cases of asleep Deep Brain Simulation.
The process in this surgery can be summarized as: the doctor inserts a long thin electric probe into the portion of the brain that causes tremors. The wire inserted runs to a device which transmits electrical impulses to interrupt signals from the thalamus that may be causing the tremors, in order to stop them. In medical centers with experience in DBS, there are usually no problems during this surgery. In case there are little problems, most times they are usually temporal and gets resolved later. There is no damage done to the brain tissue during this surgery. The patient may experience vision issues during the surgery, but they are normal occurrences during the surgery and are not permanent. This is a surgery that has offered relief to many including Brad Ackerman, whose story was earlier related.
Of course this movement disorder must be a very frustrating thing for people with it, so instead of jumping into conclusions about what we know little or nothing about or concluding that every person with shaky hands or voice is just cold, nervous or even worse a drug addict, asking questions or minding our business will the best option for us. Now that we are well enlightened about this condition, doing our best to make things easier for people with this condition must be important to us. Tremors is not the same as nervousness, being cold, being a drug addict!! Tremors is a neurological condition that is UNINTENTIONAL and UNPLANNED!!!
Writer: Stella Olanike Agboola
Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria