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Show [fYour Hand Trembles... AWRENCEL. ABT JR. LAY ON THE operating-room table—wide awake—as surgeonsat the University of Kansas Medical Center bored a holein his head. Abt, 72, aretired American Baptist minister who lives in East Bend, N.C., had suffered for years wi a tremorthat made it impossible to write or to dress himself. The surgeonsinsertedelectrodesinto his brain, then asked him to hold uphisright arm. He did. “My hand shook,ofcourse,” herecalls. “Then they turned on the power—andthe tremorstopped.It was a miracle.” That was last March. Today, Abt wears a batterypowered stimulator that was surgically implantedjust under the skin ofhis chest. It feeds an electric current into his brain and controls the tremorin his right hand, The operation,still experimental, was his last hope for a normal life. But for mostof the 5 million Americans who suffer with this disease, known medically as essential tremor(ET), treatment can be much simpler andsafer. ETcanaffect not only the handsorlegsbutalso the head and voice,as in the case of the actress Katharine Hepburn.It is not fatal, but it can mess up yourlife. It is called essential tremor because that’s all there is— atremor.It has no known cause orcure and is often confused withotherailments,particularly Parkinson’s disease, seriously debilitating condition. “Mostpatients referred to us have beentold they have Parkinson’s,” says Dr. Joseph Jankovic,professorof neurology at Baylor College of Medicine in Houston. “They're relieved to learn they have ET.” In fact, Dr. Jankovic has just given them more reasonto rejoice: His research shows that personswith ETlive longer than those withoutit, though he doesn’t know why. Mary AnnFath,43, a realestate agent in Brookhaven, N.Y., has tremors in both hands. “Somepeople seem to think I’m nervousor on alcohol,” she says. Tremors are common in her family—as theyare in the families of 50% to 60% of ETpatients. Fath’s is one of many extended familiesin an international study devotedto locating the gene respon ble for ET. Each child of a person with ET has 50% chanceofinheriting the gene. But not everyonewith the gene showsignsof tremor. Diagnosis can be tricky. Parkinson’s disease sometimes fools doctors: Parkinson’s patients have a distinct tremor when the handsandlegs are at rest. It slows down whenthe limbs are used, In ET patients, however, the tremor occurs whenthe hands and legsare in motion, notatrest. “Mostimportant ys Dr. Mitchell F. Bri ate professor of neurology at MountSinai Medi in New YorkCity,“is to acknowledge you havethe disease andto be flexible abouttrying different treatments. One option he offers notreatment, whichis the choice of Katharine Hepburn. This does not rule out adjustments such as using a larger pen or havinga glass of wine before dinner. For many, alcoholin moderation quiets tremors Jong enoughto get smoothly through a mealor a business presentation (a reactionthat can help confirm an ET diagnosis). But too muchliquor could aggravate the tremors. B Y Cc A R Y Tt can be mistaken for nervousness orParkinson’s. Often, it is a treatable disease called essential tremor, or ET. Lawrence L. Abt ur., 72, holds the magnethe uses to control the implant that stills his tremors. Mary Ann Fath (below), 43, and her family are ‘subjects of ET research. Most doctors prescribe drugs,especially propranolol or primadone. Each hasits limitations. For some patients, the drugs don’t work; for others, the side effects are uncomfortable or even dangerous. There can be a long mentperiod with these and other ET medications beforehittingthe right combination of drug and dosage “Thedrugs helped, but my hands were getting worse, ” says Calvin Bentsen, 69, a rancher in McAllen, Tex. Bentsen then tried an odd-sounding experimental treatment—an injection of botulinum toxin in his right arm. This poison, produced by contaminated food, can paralyzeandkill. But the tiny amountabsorbed by Bentsen temporarily weakened the muscles, limiting their ability to shake. Twofingers drooped an inch or more initially, but this effect went away within a few weeks. Hesays his shaking was reduced for several months The botulinuminjection, availableat only a few medical centers, has helped tremors ofthe head and voice, L 8 T E R whichare the hardestto treat with standard medications. There also is surgery. One operationis the thalamotomy,in which a smallincision is madein the thalamus, a kind of way-station in the brain, through which the tremor impulses move. The cut interrupts the flow of those impulses, It often works, but brain surgery is always risky. ‘The implantsurgery performed on Lawrence Abt,the retired minister, avoids muchofthatrisk. Abt’s implant, powered at the touch ofa special magnet, stops his tremors. Beforeresting or sleeping,he turnsoff the implantto preserveits battery, which runsthreeto five years and must be surgically replaced. “Using electrodes leaves the brain intact, and with the help of CATscans, we know exactly where we're going,” says Dr. William C. Koller, chairman ofthe neurology departmentand a professor of pharmacology at the University of Kansas Medical Center. Dr. Koller reports that 26of the 31 patients giventhe implants athis hospital were helped. 1 Forreferrals to physicians, researchers and support groups, write: International Tremor Foundation, Dept. PM,833 W. Washington Blvd., Chicago,Ill. 60607. N PAGE 12: JULY 23, 1995 PARADE MAGAZINE |
