Occupational Therapy, Physical Therapy and Alternative Therapies for Essential Tremor

Essential tremor is one of the most common adult movement disorders (1). The reported prevalence of essential tremor varies from 1% to 22% (2) though based on the most recent data of a door-to-door survey it is estimated to be 4% (3). The incidence of essential tremor increases with age (4). The etiology of essential tremor remains unknown though genetic factors play a clear role (2). The pathophysiology of essential tremor is also not completely understood though it is believed that essential tremor is a centrally mediated disease with the disturbance of olivocerebellar pathways implicated as the cause of the clinical symptoms (5). Essential tremor is characterized by postural and action tremor that typically involves the upper extremities but also can affect the voice and head. The success of available pharmacological treatments of essential tremor ranges between 40% and 65% (6). Frequently use of pharmacological agents can be limited by the low tolerance of the medications or presence of comorbidity especi lly in elderly patients restricting use of the medications. Surgical treatments of essential tremor either by ablative lesioning procedures like thalamotomy, or by placing a deep brain stimulator (DBS) in the ventral intermediatenucleus (VIM) of the thalamus are very effective and provide on average 80% tremor suppression (7).