Balance and Tremor

August 14, 2018

Essential tremor used to be considered a monosymptomatic disease. This means that it was believed that there was only one symptom of the disease, and it did not affect any other functions of the body, such as balance. Now, it is acknowledged that the action tremor is just one of many neurological features of essential tremor. These features include balance deficits and issues with gait. Before a more formal association was explored, there were anecdotal reports from clinicians that may have suggested balance side effects. 

In the studies, a number of methods were used to assess the association between balance impairment and essential tremor. The simplest method was the tandem, also known as the heel-to-toe walk. This shows even minor impairments. In general, increased number of mis-steps during tandem walk is a risk factor for future falls and other injuries due to loss of balance. A numeric value was used to compare the performance of patients with essential tremor with that of other controls. The finding ended up being that patients with essential tremor had more mis-steps during tandem walk than those without essential tremor. 

There were other scales that were used for studying balance like the Berg Balance Scale, the Dynamic Gait Index, the Timed Up and Go Test, and the Activities-Specific Balance Confidence Scale. After surveys and scales were used, results were taken to the laboratory and the patients were again studied and results quantified using lab devices. 

After looking at lab results and study results, the question is raised: Do the balance issues that come with essential tremor impact patients? It seems that when asked how confident they were in their balance, patients with essential tremor were much less confident than those without. It seems about one third of patients with essential tremor suffer from these balance impairments. Interestingly enough, those patients that have tremors in their upper extremities don’t seem to be more susceptible to balance deficits. There doesn’t seem to be any relation to tremor symptoms and balance issues. 

There are many options for symptomatic therapies that can be used in balance and tremor. Since balance and tremor have been found to go hand in hand, these therapies can treat both at the same time. The most common surgical procedure is DBS, with electrodes targeted at the thalamus. There are also studies found that traditional physical therapy and balance therapy can greatly improve balance issues that stem from essential tremor. 

Since recent research has found that essential tremor does have connections to balance problems, there has been lots of treatment and therapy options that have come available. After consulting with a medical professional and performing some basic tests to determine the severity of the balance issues, surgical and physical therapy options are available. These treatments have been reported to have great success, and balance can improve in those who suffer with essential tremor. Balance is something that is necessary for daily function, so staying on top of your symptoms and learning what works for you is very important for those with essential tremor.