klonopiN

I always like to mention there is one person here I know very well who had excellent results on Neurontin and remains on it.

Also, the irony of life. I seem to be developing an "essential tremor" -- I inherited this from my father who had to stop performing surgery in his late 60's I believe. The tremor in his hands was rather bad, but he lived until 84, and it was a bad heart that did him in.

I have calmed down a bit about this, though I am not thrilled. I see a neurologist in June.

Thing is, what is used to treat essential tremor? Inderal (which is one drug that was one of the worst meds I've ever taken -- gave me heart problems that were not permanent and didn't help my anxiety), and BENZOS! Well, I'm already on 6mg Klonopin and have been for many years. I just like to counter Joe's experience with a tad more positive one for me.

Everyone is different.

Also, it is recommended for people with essential tremor who avoid social situations because of shaking hands have a DRINK OR TWO, LOL. Seriously.

I can't drink!!!! It makes the DP/DR much worse!

There is one other med that is a possiblity. I don't need something like that now, but this tremor REALLY has gotten bad suddenly. Due to a LOT of stress. I'm going to hold off on any more meds, however:

1. I have never grown tolerant to Klonopin (6mg/day) since 1987. I'm now on the generic clonazepam.

2. It is recommended (actually various benzos) for a large number of the population with tremors. (This increases over age 40, though not every older person gets tremors).

My point ... we're all unique, and Joe I'm not posting this to bug you. I had to laugh when I found out the treatment for this essential tremor, which I have apparently inherited from my father, is treated with benzos and alcohol, LOL.

Cheers folks ... hic 8)
:mrgreen:
At least I can laugh at this this week. I was a disaster over this since I got the pretty clear Dx. Final Dx in June by the neurologist. My father's tremor made the GP say, "Oh, yeah, essential tremor" as he made my hands shake more with various neurological tests. SIGH.

ONE THING AFTER ANOTHER!
Dreamer

Joe, Joe, Joe ....

Sometimes a cigar is just a cigar, and sometimes a physical illness is just a physical illness. You need to be informed.

See this excellent link to essential tremor. My father had it. He was never on a psychotropic med in his life. He was born in 1906 for God's sake, LOL. Never believed in psychiatry. He self medicated his tremor with alcohol, NOT in excess!

Also, my tinnitus was caused by an ear infection. It's gone. I have a bad sinus which I had surgery for back in 1993. Also had my tonsils out. Infections ceased as did tinnitus. When infections return with FAR less frequency, I occasionally get tinnitus. No connection with Klonopin. A course of antibiotics eliminated it. I don't have tinnitus!!!!

Joe, you have to READ reputable sources. And I have seen not only my shrink, but my GP, a medical resident, and will be seeing a neurologist in June. The GP diagnosed "essential tremor"!

Here's stuff on essential tremor. Also, I recently have had 4 vials of blood drawn which is being analyzed for differential diagnosis which could be a thyroid problem, and about a million other things.

Benzos are used in medicine for many things. Try living with essential tremor. If you have something that works to improve quality of life, you use it. You have an informed decision to make, yes. I'm not going to increase my Klonopin, or add any Benzos myself, or start drinking, LOL. I will wait for my blood tests, and see the neurologist. Per 3 doctors so far this has NOTHING to do with any psychotropic med I'm on.... particularly Klonopin!

There are a lot of folks out there who can't function with essential tremor. And many who get it who've never been on psychiatric meds!!! Good grief. In rare cases, newborns have essential tremor!!!!

Ya' gotta believe me Joe, that this is MY way of treating myself. I'm not pushing it on anyone. I'm giving another view is all.
--------------------------------------------------------------------------
READ THIS!!!!!
http://www.emedicine.com/neuro/topic129.htm

Causes: ET probably represents a syndrome; multiple etiologies can be identified. Most or all of these causes are probably genetic.

ET is familial in at least 50-70% of cases. Transmission is autosomal dominant, with incomplete penetrance. Some cases are sporadic with unknown etiology.

Variations in methodology (assessment procedures and diagnostic criteria) account for the wide variation in findings; reported studies have found that 17% to almost 100% of cases are familial.

One study demonstrated an increase from 67.7% to 96% of cases having an affected relative after repeated and varying questioning, followed by direct interviewing of family members. MY FATHER HAD THIS! HE HAD TO STOP BEING A SURGEON BECAUSE OF IT!!!!! I am not pleased!!!!!

Genetics: Two susceptibility loci have been found.

The FET1 gene is located at 3q13 and was identified in 75 members of 16 Icelandic families.

Another locus, 2p25-22, was identified in 15 members of 4 generations of Americans. Abnormalities found in 3 additional American families have been reported to map to this locus.

In one family with levodopa-responsive, autosomal dominant, Lewy body parkinsonism, a chromosome arm 4p haplotype that segregates with the disease was identified. This haplotype also occurred in individuals in the family who did not have parkinsonism but rather a postural tremor consistent with ET. This suggests that in some cases postural tremor can be an alternative phenotype of the same mutation.

Associations between ET and Parkinson disease (PD) and ET and dystonia have been suggested.

ET has been hypothesized to be a risk factor for the development of PD. Some patients with PD report a longstanding history of bilateral upper extremity postural tremor. Without biological markers for these diseases, determining whether longstanding postural tremor is part of a PD syndrome or reflects the presence of both ET and PD is not possible.

Some patients with focal dystonia, such as torticollis, have mild bilateral upper extremity postural tremors. Without biological markers for these diseases, determining whether postural tremor is part of a focal dystonia syndrome or reflects the presence of both dystonia and ET is not possible.

Other diagnostic considerations: The Movement Disorders Society has proposed the following diagnostic criteria for classic ET:
Inclusion criteria are as follows:

Bilateral, largely symmetric postural or kinetic tremor involving hands and forearms that is visible and persistent

Possible additional or isolated tremor in head but absence of abnormal posturing
Exclusion criteria are as follows:

Other abnormal neurologic signs, especially dystonia

The presence of known causes of enhanced physiologic tremor, including current or recent exposure to drugs that are known to cause tremor or a drug-withdrawal state. Per my doctors, this does NOT apply to me. My genetic propensity is the suspect.

Historic or clinical evidence of psychogenic tremor

Convincing evidence of sudden onset or evidence of stepwise deterioration

Primary orthostatic tremor

Isolated voice tremor

Isolated position-specific or task-specific tremors, including occupational tremors and primary writing tremor

Isolated tongue or chin tremor

Isolated leg tremor

DIFFERENTIALS Section 4 of 9
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Bibliography

Arsenic
Caffeine - I DON'T drink this anymore because of its worsening my DP and causing the tremor to get worse.
Multiple System Atrophy
Parkinson Disease
Parkinson-Plus Syndromes
Thyroid Disease
Torticollis
Wilson Disease
------------------------------------------------------------
I pray to God I don't have Parkinson's. It was suggested since my mother said my father HAD Parkinson's I could have that. God help me. But my mother was nuts. She'd say things that weren't true 87% of the time.

I'll find the treatment section.

The neurological visit and bloodwork wlll be a process of elimination. My GP was about 90% certain this is essential tremor which is YES exacerbated by anxiety and stress. I'm a MESS! What can I do? Buddhist thought, yoga, some vitamin treatments -- RADICAL ACCEPTANCE. Living every day to its fullest.

This is edited.
Treatments for Essential Tremor -- I am NOT PLEASED, but what

choices do I have, Joe?????

Medical Care: Primidone and propranolol are the cornerstones
of maintenance medical therapy for ET. These medications provide
good benefit in reducing tremor amplitude in approximately 75% of
patients.

......................

Some patients require only intermittent tremor reduction, such
as when attending a meeting or engaging in a social activity. For
these patients, a cocktail or beer prior to the activity may be
sufficient.

An alternative is propranolol (10-40 mg)
approximately one half hour prior to the event. Alcohol consumption
is not an appropriate maintenance therapy for patients who seek
tremor reduction throughout the day.

Alcohol

.......

The mechanism of tremor reduction by alcohol is unknown. In a
double-blind study, the 6-carbon alcohol methylpentynol did not
have any effect on tremor. This suggests that the alcohol group of
ethanol is not the element that provides antitremor activity and
that ethanol's antitremor effect is not due to sedation.

Restricted intra-arterial ethanol administration does not reduce
tremor in the perfused limb. This suggests that ethanol's effect is
mediated centrally.

Propranolol - I can't drink and I can't use Propanolol, the first logical line of treatment

Winkler first noted remarkable tremor reduction in a patient
treated with propranolol for paroxysmal atrial tachycardia.
In a double-blind crossover study, propranolol at doses from 60-240
mg/day reduced tremor in 75% of patients with ET. In a
dose-response study, 240-320 mg/day was found to be the optimal
dose range with no additional benefits above 320 mg/day.

Average tremor reduction is 50-60%, but some patients experience
marked tremor reduction and others no benefit.

.............................

Primidone

O'Brien initially observed that primidone, when administered to a
patient with epilepsy and ET, reduced tremor. In a
placebo-controlled study, primidone significantly reduced tremor in
otherwise untreated patients and patients treated with propranolol.

Doses greater than 250 mg per day did not provide additional
benefit.

The mechanism of action is unknown. Active metabolites are
phenylethylmalonamide (PEMA) and phenobarbital. PEMA has no effect
on tremor, and phenobarbital has only modest effect on tremor.

Tremor reduction is not correlated with serum levels of primidone
or phenobarbital.

Clozapine

A single dose of 12.5 mg clozapine and placebo were compared in a
randomized, double-blind, crossover study in patients with
drug-resistant ET. Tremor was reduced significantly by clozapine in
13 of 15 patients (P<0.01).

A significant reduction of tremor was reported with long-term
(open-label) clozapine therapy (39.9 mg/d).
No tolerance was observed over 15 months.

Mirtazapine

In a small, open-label case series, mirtazapine was reported to
reduce tremor in patients with ET and PD.
Currently the authors often try mirtazapine as a second-line agent.

Gabapentin: A double-blind crossover trial comparing
gabapentin (400 mg tid) to propranolol (40 mg tid) found that both
drugs demonstrated significant and comparable reductions in tremor
compared to baseline. However, a double-blind, placebo-controlled,
crossover study identified no difference between gabapentin and
placebo.

Benzodiazepines: Benzodiazepines, particularly clonazepam
and alprazolam, are used commonly in the treatment of ET, but their
effectiveness is limited. They probably work to reduce anxiety that
can amplify tremor amplitude.

Botulinum toxin: Botulinum toxin has been evaluated for the
treatment of ET. Its use in the treatment of tremor of the upper
extremities is limited because it commonly causes weakness. It is
more useful in the treatment of head tremor, as it often provides
benefit without unwanted troublesome weakness.
Practical management of pharmacologic therapy

If sufficient benefit is not achieved with primidone or
propranolol, other medications are considered based on the severity
of the residual tremor.

The authors often try mirtazapine as a second-line agent.
If the tremor is mild and more of a nuisance than disabling,
benzodiazepine is considered, usually clonazepam.

If the tremor is severe or causing disability, clozapine is
introduced next. Blood monitoring is required with this drug, and
patients sign informed consent in the light of the rare risk of
agranulocytosis.

For patients with head tremor, cervical injections of botulinum
toxin may be given.

Surgical Care: For patients with medically refractory,
disabling upper extremity tremor, surgery is considered.
Stereotactic thalamotomy and thalamic ventralis intermedius nucleus
deep brain stimulation (DBS) are the procedures of choice.

----------------------------------------------

DEAR GOD I DON'T WANT SURGERY. BUT I'LL DO IT IF THIS
PROGRESSES. MAYBE IT'LL HELP THE DP FOR GOD'S SAKE. I have to pick my poison on this. I'm really scared.

Joe, I could really use a little emotional support here. I
appreciate that you have not been as agressive with the anti-benzo
stance which IS legitimate in many cases. NOT IN MINE

Peace,
Dreamer

dakotajo said:

Well...I went thru tremors during my klonopin addiction and withdrawal. I also got the morning tremors during my alcoholic daze. Ive read all over the place this can be caused by weakened gaba and unchecked adrenaline.

I dont know why you have tremors but I think you will be in denial no matter what. I guess thats what addiction is all about.

Click to expand...

Joe, I don't need this. Why do you say this to me, when MANY others on this Board take benzos, and others take MORE meds than I do? I've asked you this in PMs a million times. You never answer the question. Why me? I don't dare diagnose you. How dare you diagnose me? HOW DARE YOU? How dare ANYONE on this board apply there one experience to others? HOW DARE ANYONE ASSUME WHAT IS WRONG WITH ANY OF US?

I apologize if I have ever done that.

So my GP who spent an hour on me, the nurse who took 4 vials of blood and also observed me, the medical resident tagging along with my GP looking up everything in the PDR for the GP.... doesn't matter to you. They're all idiots I assume.

I have had a small bilateral tremor in both hands... an INTENTION tremor, not a RESTING tremor... for about 2 years. It has gotten much worse since: (Do you know the difference between resting and intention tremor, bilateral vs. unilateral?) Have you had a neurological exam for essential tremor or Parkinson's? Do you have a family member with ET?

Recent stressors:

1. My dear friend commited suicide
2. I started prepping to move
3. I plan on starting a regular volunteer position
4. I found I may have colon polyps -- surgery in July

That's about enough stress, hmmm? But I've been managing my DP/DR better since my DBT therapy (4 months).

I also have a slight bilateral tremor in my jaw, and sort of a tic in my neck. Bilateral tremor in my upper arms... only INTENTION tremors. These are all INTENTION tremors, not occuring in a resting state. That is when I make a move to do something. Same with my father -- exactly. I am at an age when this usually starts. Over 40. I'm 46.

Homeskooled, I appreciated what you said AND HOW YOU SAID IT. With concern and kindness.

Joe, I don't need to be lectured that I am in denial.
My GOD I've never know anyone more cruel in my entire life save my mother and that's saying a helluva lot.

SORRY TO EVERYONE ELSE HERE. I AM AN IDIOT EVERY TIME I TRY TO POST IN REPONSE TO WHAT JOE SAYS. I'M CREATING THIS PROBLEM FOR MYSELF. SORRY DA'BURGH FOR HIJACKING YOUR POST. ANY MODERATOR IS WELCOME TO DELETE THIS AFTER JOE HAS SEEN IT. DENIAL MY ASS.

Dear Shelly,

Again, sorry off Da'Burgh's topic.
Yup, spot on, on this one... another reason for my increased anxiety...
And thank you for your support.

I was adviced to have one three years ago even though the gastroenterologist diagnosed me with IBS.He wanted to rule out anything else.The reason I haven't had it is because of the anesthetic.
It's crazy but I'm not at all concerned of the idea of procedure,its the sedation that scares me.

Click to expand...

Anesthesia absolutely terrifies me -- exactly the same. I'm so afraid this will exacerbate the DP/DR. But I can't worry about it. I also have IBS. I am a MESS. Definitely diagnosed by a great gastro when I was 40. He told me I was the most stressed out person he ever met, I swear it. He also said the SSRIs are the first line of treatment for that (there is serotonin in the gut). Well, I'm already on Celexa.

Also, the early logical treatment for ET are the meds I'm on. Or they should help with my anxiety. I'll say today, after going through a hideous period of anxiety over everything, I'm now less anxious overall (I don't feel anxious at least) and the tremor seems to be less again -- very, very mild -- don't really notice it. It's obvious that current stressors exacerbated it, and I have to watch for this in the future.

I've also read about Parkinson's and I don't believe my father had it, or that I have it. It has symptoms of rigitity, slowness of motion, LOSS of function aside from the tremors. I.E. again like Pope John Paul. In his last years he started looking like a stone ... that is the hallmark ... or more of a hallmark of Parkinson's. My father didn't have that, and I haven't exhibited that. Also loss of balance, etc. I don't have that.

Here's the thing. I have an incredibly high level of anxiety that is in a sense "constant" ... rumbling beneath the surface. When the anxiety increases the DP/DR kicks in full force, else the DP/DR is relatively stable.

Interesting I've been this way since a kid (save for the DP/DR until I hid about 12 or so.)

Anyway, my psychiatrist and the GP noted (as well as that first Gastro who simply did a biopsy on me) that I am on all the right meds right now to help all of my wonderful extra conditions.

It's wait and see. I feel I need to do the colonoscopy. I've also put it off and it has to be done.

Again Da'Burgh, don't sweat the many vicious versions of anxiety that can express itself in different people in different ways. Also remember, one can have other physical illnesses ASIDE from a mental illness. The best way to do that is consult a doctor. No one here can diagnose you. No one here is an expert.

I feel better, the last few days. I will stumble along as I have for so long. I have decided to take this as a challenge. I have no choice. And fortunately, it didn't seem to bother my father, save again, he had to stop his livelihood, but he continued in medicine as a consultant, so he did continue to work, nearly until 80! He was an expert with a mind like a steel trap at diagnosis of X-Rays of the thoracic area.

I think I'm over my terror re: all of this. I have no control over it right now.

Best,
D
Back to prepping for my move. So many darned details!