TO YOUR GOOD HEALTH By Keith Roach M.D.
DEAR DR. ROACH: I have been diagnosed with essential tremor. Propranolol 10 mg has not helped. Sometimes I can write and eat with no shaking, but other times the shaking is so bad that the food falls off the fork or I cannot read my printing or writing. If I drink a beer, it seems to relax me enough that in five minutes I can write or eat quite normally nearly every time. I’ve been told that it doesn’t appear to be Parkinson’s. Any suggestions will be enormously appreciated. – J.N.
ANSWER: Essential tremor, sometimes called benign familial tremor, is common. Often, one has a family history of tremor. It is not Parkinson’s disease; however, it isn’t always “benign” in that, for some people, it can be disabling, preventing a person from not only writing, but, as in your case, activities of daily living such as eating.
Alcohol has long been known to reduce the tremor temporarily, but it must be taken cautiously, since regular use will diminish its effectiveness, requiring higher doses for effectiveness – and, as I have written many times, excess alcohol is a major cause of many medical problems. Occasional use with meals is reasonable.
Other effective treatments for essential tremor include anti-epilepsy medications such as primidone, gabapentin and topiramate. Unfortunately, all of these can have side effects, so they are best prescribed by an expert, such as a neurologist who specializes in movement disorders.
For serious essential tremor not responsive to medications, deep brain stimulation (via electrodes placed surgically) is effective.
DEAR DR. ROACH: My mother was diagnosed with Alzheimer’s disease in 2009, and she is taking Namenda and Aricept to help slow the advancement of the disease. I am writing because she complains of being cold all the time. She and my father keep the temperature in their house at 80 degrees, and my mother wears winter clothes, a coat and a blanket in the house. She sometimes sweats through the clothes, but we can’t persuade her to remove any layers. The house is uncomfortably hot for anyone else, and yet she says she is cold.
Her general practitioner has said that this is part of her disease. Is there anything else you have heard of that could explain this? – C.L.
ANSWER: I have seen a lot of people with dementia of all kinds, but I haven’t personally seen this degree of intolerance to cold. Her doctor may have more experience than I do, but I didn’t find much about it written in the medical literature. Every person is different, and it’s possible this is just part of how the dementia is affecting her.
However, cold intolerance to this degree suggests some alternate possibilities. The most important and likely is low thyroid levels, which can also cause a condition that looks like dementia and would certainly make dementia worse. I bet her doctor has checked for it. If not done recently, she should have her thyroid level checked.
Other, less-common causes include Addison’s disease (inability to make appropriate amounts of steroid hormones), iron deficiency, anemia from any cause and severe malnutrition.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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