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COVID-19 and Essential Tremor

A movement disorder specialist answers important questions about how COVID-19 affects those with essential tremor.

Hand trembling while writing

What is essential tremor?
It’s a movement disorder that affects more than 10 million people in the United States and is characterized by involuntary shaking or tremors, which occur most often in the hands. It also can affect other parts of the body, including the head, voice, arms, or legs. If the shaking becomes severe, it can interfere with daily activity and cause disability. Some people may have difficulty picking coins out of their wallets, for example, or holding and typing on a smartphone, eating soup, drinking, or writing.

How has COVID-19 affected people living with essential tremor?
There are no reports that getting COVID 19 can worsen tremors or other symptoms; however, the pandemic has heightened anxiety for many people, and for those with essential tremor, that increase in anxiety can worsen a tremor. In addition, people who rely on friends, family, and caregivers to help with housework, cooking, or other domestic responsibilities may not have this support during the pandemic. The stress of social isolation or lack of employment leading to financial struggles are other stressors that could result in more tremors.

How is essential tremor treated?
Medications such as the beta-blocker propranolol (Inderal) and antiseizure medication such as primidone (Mysoline) have been shown to be beneficial for some patients. These medications, however, are only 50 to 70 percent effective and have potential side effects. Beta blockers may lower heart rate or cause fatigue, dizziness, or depression while topiramate may cause cognitive dysfunction, weight loss, and numbness around the lips and or fingertips. Other treatments include deep brain stimulation (DBS), which was approved by the US Food and Drug Administration for use with essential tremor in 2002. This surgical procedure involves placing an electrode in the brain that’s connected to a pacemaker-like device in the chest. Another option—focused ultrasound—uses an MRI and ultrasound to burn a very small area in the brain that causes tremor. Both options provide tremor relief with different side effects. A non-invasive, non-pharmaceutical treatment is a neuromodulation device such as one called Cala Trio, which is worn on the wrist and delivers electrical stimulation directly to the nerves in the wrist. These devices, which are available by prescription and can be evaluated via telehealth, are designed to treat essential tremor by using the body’s circuits.

Are there any medications people with essential tremor should stop taking if they get COVID-19?
People with essential tremor should discuss their COVID-19 diagnosis with their doctors before making any medication changes. Patients on beta blockers, which are typically not recommended for people who have asthma or bronchospasm (narrowing and/or blocking of the airways) because beta blockers can exacerbate these conditions, should talk to their doctor if they have breathing problems related to COVID-19. Similarly, since confusion or memory problems can be symptoms of COVID-19, patients and their doctors should review any medications that may affect memory, some of which include antiseizure medications used for essential tremor.

During the pandemic, how might a neurologic exam be different?
The main difference is that a neurologic examination might be conducted via videoconference rather than in-person. Fortunately, most portions of an exam—assessing tremor, obtaining a writing sample, and observing speech and gait—can be done remotely.

How can people with essential tremor prepare for a telehealth visit?
Make sure you have a good internet connection and a camera on your computer or iPad. Place your computer on a table and make sure your face and upper body are showing. Have a piece of paper and pen handy to draw spirals and produce a writing sample.

How should patients talk with their health care provider about their condition?
Patients should speak openly about their tremor and how it affects their day-to-day life and ask about the available treatments. They should work with their doctors to find the right therapy that can help them improve their quality of life and perform activities of daily living.

Read More:

COVID-19 (Coronavirus) and Neurologic Disease Resource Center