Essential tremor in Children

A great deal of research has been done to identify the cause and treatment of essential tremor (ET) in adults, but information about ET in children is generally lacking. Recently, doctors summarized all of the research that has been published on this topic, showing that huge gaps still exist in our knowledge about ET in children.

Clinical Manifestations
As do adults, most children go to the doctor for treatment of a tremor of the hand because the tremor interferes with writing or other daily activities. The most common type of tremor in children is an action tremor—a tremor that appears when the child performs an action such as writing or tying shoes. The tremor most often affects both sides of the body. Tremor in children is rarely debilitating before the age of 15. Boys are more affected by ET than are girls. As in adults, the tremor in children becomes worse over time. By adolescence, many children with ET seek treatment because of the worsening tremor.

Just as in adults, treatment for ET is not given to all children with ET. Treatment is usually given to those children for whom the tremor interferes with daily functioning or social interaction. Because many children have only a mild tremor, they often do not require medical treatment. However, because of the progressive nature of ET, many children will require intervention by the time they reach mid to late adolescence.

Two medications often used in adults with ET have been tested in children as well, but neither drug has been tested in controlled studies. One drug, propranolol, blocks the action of epinephrine and norepinephrine in the body. In a database of their patients, Dr. Joseph Jankovic and his colleagues at Baylor College of Medicine in Houston, TX, identified 12 children with ET who had been taking propranolol; five continued to take the drug and had a noticeable improvement in their tremor. Primidone, an anti-seizure medication, has been shown to help some adults with ET. In Jankovic’s study, the tremor improved in two of the nine children with ET who took primidone.
Drug studies are difficult to conduct in children because the benefits of treatment must be weighed against any potential harm that the drug might cause. This is particularly burdensome because the harm may be different in children, whose bodies are rapidly developing, than in adults. Both medications for the treatment of ET work best in adults and children who have ET of the hand or forearm; they are less effective for those with ET of the head or neck.

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