Stop the shaking: options for brain injury-induced tremor

Reducing tremor can make a world of difference on day-to-day function, increasing the patient’s ability to work [if they are still young] and to live life to the fullest.
Reducing tremor can make a world of difference on day-to-day function, increasing the patient’s ability to work [if they are still young] and to live life to the fullest.

The tremor that can occur as the result of brain injury can make everyday movements and activities that we take for granted feel impossible - everything from brushing your teeth and hair, to writing, typing, using cutlery, and driving is suddenly a mountain to climb.

“[Unlike] other organs where you might have trauma and with the passage of time they heal, the brain doesn’t have that capacity to repair itself,” Neurosurgeon Professor Richard Bittar, who practises in Victoria and Tasmania, said.

“If the part of the brain that’s damaged [is] responsible for movement, your ability to talk, [move,] and walk can be affected. This can [significantly] impact the patient’s quality of life.”

In some cases, brain damage can cause movement disorders, either spasticity - when certain muscles continuously contract - and post-traumatic tremor, “where one side of the body can’t stop shaking,” Bittar explained.

“Patients often are embarrassed by their tremor and withdraw socially – they don’t want to be seen shaking in public.” Depression is common in the aftermath of a brain injury, he said.

Who’s at risk?

Brain injury can strike at time at any time of life, but there are two groups most vulnerable to brain injury, according to Bittar:

“Young males, usually due to a motor vehicle or cycling accident, or an assault. Then you’ve got the older population. People are living longer these days and they want to live at home; they don’t want to be in facilities like nursing homes.

“As you get older your brain shrinks and your blood vessels weaken…so even a minor head injury from a fall in the home or on the street can have a devastating result; effectively the brain is more vulnerable. You can have a blood vessel that ruptures, or the brain can rattle around inside the skull, [sustaining] trauma against the inside of the skull.”

Treatment

Deep brain stimulation can make a huge difference for a brain injury patient with post-traumatic tremor, Bittar said. Performed under local anaesthetic, it involves “electrodes being placed on particular areas of the brain.

“In most cases we can dramatically improve or [eradicate] tremor,” Bittar said. “I’ve had a number of patients who’ve had a head injury and recovered well other than having an ongoing tremor.

“Deep brain stimulation attempts to shut down tremor, works in the majority of patients and makes a big difference to quality of life - especially if it’s affecting the side of the body that the patient uses most, depending on whether they’re right or left handed.

“Reducing tremor can make a world of difference on day-to-day function, increasing the patient’s ability to work [if they are still young] and to live life to the fullest.”

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