Essential tremor: diagnosis, propranolol and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Le tremblement essentiel est le tremblement neurologique le plus fr\u00e9quent, cin\u00e9tique et postural, touchant les mains et la t\u00eate. 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tremor<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Le tremblement essentiel (TE) est le trouble du mouvement le plus fr\u00e9quent chez l'adulte \u2014 affectant 0,9 % de la population g\u00e9n\u00e9rale + et jusqu'\u00e0 4\u20135 % des personnes de plus de 65 ans \u2014 caract\u00e9ris\u00e9 par un tremblement bilat\u00e9ral + rythmique + de fr\u00e9quence mod\u00e9r\u00e9e (4\u201312 Hz) + principalement cin\u00e9tique (lors des mouvements volontaires) et postural (lors du maintien d'une posture contre la gravit\u00e9) + touchant le plus souvent les membres sup\u00e9rieurs (mains et avant-bras) + et parfois la t\u00eate (tremblement oui-oui ou non-non) + la voix + le menton \u2014 en l'absence d'autres signes neurologiques (pas de rigidit\u00e9 + pas de bradykin\u00e9sie + pas de signes c\u00e9r\u00e9belleux). Anciennement d\u00e9sign\u00e9 tremblement b\u00e9nin ou tremblement familial (en raison de sa fr\u00e9quente transmission familiale autosomique dominante avec p\u00e9n\u00e9trance variable \u2014 jusqu'\u00e0 50\u201370 % des cas sont familiaux), le terme \u00abb\u00e9nin\u00bb est d\u00e9sormais abandonn\u00e9 car le tremblement essentiel peut \u00eatre tr\u00e8s invalidant dans ses formes s\u00e9v\u00e8res \u2014 g\u00eanant l'\u00e9criture + la manipulation d'ustensiles + la boisson dans un verre + les activit\u00e9s professionnelles + et entra\u00eenant un isolement social significatif. La physiopathologie implique une d\u00e9r\u00e9gulation des circuits c\u00e9r\u00e9bello-thalamo-corticaux \u2014 avec une hyperactivit\u00e9 oscillatoire du cervelet + du noyau dentel\u00e9 + et du thalamus ventral interm\u00e9diaire (VIM) \u2014 expliquant pourquoi la stimulation c\u00e9r\u00e9brale profonde (DBS) ciblant le VIM + ou la thalamotomie focalis\u00e9e (ultrasons focalis\u00e9s guid\u00e9s par IRM \u2014 MRgFUS) ont une efficacit\u00e9 remarquable dans les formes r\u00e9fractaires. Le tremblement essentiel se distingue du tremblement parkinsonien principalement par son caract\u00e8re cin\u00e9tique et postural (vs de repos dans la maladie de Parkinson) + l'absence de signes parkinsoniens associ\u00e9s + et sa r\u00e9ponse \u00e0 l'alcool (r\u00e9duction temporaire souvent rapport\u00e9e par les patients) + et aux b\u00eatabloquants.\n <\/div>\n\n <h2>Caract\u00e9ristiques cliniques et distinction du tremblement parkinsonien<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Characteristic<\/th>\n <th>Essential tremor<\/th>\n <th>Parkinsonian tremor<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Type of tremor<\/td>\n <td>Cin\u00e9tique (pendant le mouvement) + postural (maintien de la posture) ++ \u2014 s'aggrave lors de l'action<\/td>\n <td>De repos (au repos, dispara\u00eet lors du mouvement volontaire) ++ \u2014 \u00abpill-rolling\u00bb<\/td>\n <\/tr>\n <tr>\n <td>Frequency<\/td>\n <td>4\u201312 Hz (plus rapide)<\/td>\n <td>3\u20136 Hz (plus lent)<\/td>\n <\/tr>\n <tr>\n <td>Location<\/td>\n <td>Mains + avant-bras bilat\u00e9raux ++ + t\u00eate + voix + menton<\/td>\n <td>Mains +++ + membres inf\u00e9rieurs + menton \u2014 asym\u00e9trique au d\u00e9but<\/td>\n <\/tr>\n <tr>\n <td>Sym\u00e9trie<\/td>\n <td>Bilat\u00e9ral et sym\u00e9trique d\u00e8s le d\u00e9but<\/td>\n <td>Unilat\u00e9ral au d\u00e9but \u2192 bilat\u00e9ral plus tardif<\/td>\n <\/tr>\n <tr>\n <td>Signes associ\u00e9s<\/td>\n <td>AUCUN signe neurologique associ\u00e9 (pas de rigidit\u00e9 + pas de bradykin\u00e9sie + pas de signe pyramidal)<\/td>\n <td>Rigidit\u00e9 + bradykin\u00e9sie + instabilit\u00e9 posturale + hypomimie + micrographie<\/td>\n <\/tr>\n <tr>\n <td>Effet de l'alcool<\/td>\n <td>Am\u00e9lioration temporaire dans 50\u201370 % des cas (crit\u00e8re diagnostique informel)<\/td>\n <td>Peu ou pas d'effet de l'alcool<\/td>\n <\/tr>\n <tr>\n <td>\u00c9criture<\/td>\n <td>Grande \u00e9criture irr\u00e9guli\u00e8re + trembl\u00e9e (macrographie tremblante)<\/td>\n <td>Petite \u00e9criture serr\u00e9e + trembl\u00e9e (micrographie)<\/td>\n <\/tr>\n <tr>\n <td>Family history<\/td>\n <td>Fr\u00e9quente (50\u201370 % \u2014 autosomique dominant)<\/td>\n <td>Moins fr\u00e9quente (10\u201315 % \u2014 formes g\u00e9n\u00e9tiques)<\/td>\n <\/tr>\n <tr>\n <td>R\u00e9ponse \u00e0 la l\u00e9vodopa<\/td>\n <td>Absent or minimal<\/td>\n <td>Excellente (crit\u00e8re diagnostique de la maladie de Parkinson)<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Causes de tremblements \u00e0 distinguer du tremblement essentiel<\/h2>\n <ul class=\"co-list\">\n <li><strong>Tremblement physiologique accentu\u00e9 :<\/strong> anxi\u00e9t\u00e9 + stress + caf\u00e9 + m\u00e9dicaments (caf\u00e9ine + bronchodilatateurs \u03b22 + lithium + valproate + amiodarone + antid\u00e9presseurs + cortico\u00efdes) + hyperthyro\u00efdie + hypoglyc\u00e9mie + sevrage alcoolique \u2192 tremblement postural rapide (> 8 Hz) + fin + r\u00e9versible \u2192 bilan TSH + glyc\u00e9mie + r\u00e9vision m\u00e9dicamenteuse<\/li>\n <li><strong>Parkinson's disease:<\/strong> asymmetric resting tremor + rigidity + bradykinesia + flexed posture + small-step gait \u2192 DaTscan (dopaminergic SPECT) if diagnostic doubt exists<\/li>\n <li><strong>Tremblement c\u00e9r\u00e9belleux :<\/strong> intention tremor (worsens as target approaches) + dysmetria + ataxia + nystagmus \u2192 MS + cerebellar atrophy + alcoholism + drugs (phenytoin)<\/li>\n <li><strong>Orthostatic tremor :<\/strong> lower limb tremor on standing \u2192 high frequency (13-18 Hz) + disappears on walking or sitting \u2192 diagnosis by surface EMG<\/li>\n <li><strong>Dystonic tremor :<\/strong> irregular tremor associated with dystonic posture + head tilt in spasmodic torticollis<\/li>\n <li><strong>Wilson's disease :<\/strong> young adult + tremor (often winged) + hepatic + psychiatric signs + Kayser-Fleischer ring \u2192 cupremia + ceruloplasmin<\/li>\n <\/ul>\n\n <h2>Pharmacological treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Propranolol (traitement de premi\u00e8re ligne) :<\/strong> non-selective beta-blocker + 20-320 mg\/d (progressive titration) + LP forms available (40-160 mg\/d in one dose) + 50-70 % reduction in tremor + mechanism: peripheral blockade of muscle \u03b22 receptors + possible central mechanism + contraindications : severe asthma + severe COPD + AVB + bradycardia + decompensated heart failure + insulin-dependent diabetes (masks hypoglycemia) + side effects: fatigue + bradycardia + hypotension + bronchospasm + erectile dysfunction + DO NOT stop abruptly (risk of rebound)<\/li>\n <li><strong>Primidone (traitement de premi\u00e8re ligne) :<\/strong> antiepileptic \u2192 metabolized into phenobarbital + reduction of tremor by 50-70 % + start at very low doses (12.5-25 mg at bedtime) \u2192 very slow titration (every 1-2 weeks) to avoid initial side effects + effective dose: 50-750 mg\/d in 2-3 doses + side effects: sedation (especially in early stages) + dizziness + nausea + ataxia + physical dependence + do not stop abruptly (risk of convulsions)<\/li>\n <li><strong>Propranolol + primidone combination:<\/strong> superior efficacy to each drug alone in moderate to severe forms<\/li>\n <li><strong>Topiramate :<\/strong> 25-200 mg\/d \u2192 moderate efficacy + useful if propranolol and primidone insufficient or poorly tolerated + side effects: cognitive problems (words on the tip of the tongue) + weight loss + nephro-lithiasis<\/li>\n <li><strong>Gabapentin :<\/strong> 300-3,600 mg\/d + more limited data + useful as an alternative or in combination<\/li>\n <li><strong>Benzodiaz\u00e9pines (clonaz\u00e9pam + alprazolam) :<\/strong> modest antitrembling effect + but useful in occasional stress situations aggravating tremor (presentation + meeting + meal) + risk of dependence + not recommended as long-term background treatment<\/li>\n <li><strong>Botulinum toxin injection:<\/strong> forearm muscles (hand tremor) + sternocleidomastoid muscles (head tremor) \u2192 efficacy 50-70 % + duration 3-4 months + side effects: muscle weakness + particularly useful for cephalic and vocal tremor<\/li>\n <\/ul>\n\n <h2>Traitement chirurgical \u2014 formes s\u00e9v\u00e8res r\u00e9fractaires<\/h2>\n <ul class=\"co-list\">\n <li><strong>Stimulation c\u00e9r\u00e9brale profonde (DBS \u2014 Deep Brain Stimulation) du VIM thalamique :<\/strong> implantation of electrodes in the ventral intermediate nucleus (VIM) of the thalamus + continuous electrical stimulation \u2192 interruption of pathological oscillations + reduction of tremor by 80-90 % + reversible + adjustable + bilateral possible + risks: infection + intracerebral hemorrhage + dysarthria (bilateral) + generator complication<\/li>\n <li><strong>Thalamotomie par ultrasons focalis\u00e9s guid\u00e9s par IRM (MRgFUS \u2014 Exablate) :<\/strong> focal thermal destruction of VIM by ultrasound + without surgical opening + under real-time MRI + efficacy 80-90 % + advantage: non-invasive + immediate + permanent + disadvantage: unilateral only (risk of dysarthria if bilateral) + irreversible + available in Quebec (CHU)<\/li>\n <li><strong>Gamma-knife (radiochirurgie st\u00e9r\u00e9otaxique) :<\/strong> thalamotomy by targeted irradiation + delayed effect (3-6 months) + risk of permanent adverse effect (neurological deficit)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>L'am\u00e9lioration du tremblement essentiel par l'alcool \u2014 rapport\u00e9e par 50 \u00e0 70 % des patients \u2014 est un crit\u00e8re diagnostique informel classique mais cliniquement important. Ce ph\u00e9nom\u00e8ne r\u00e9sulte de l'action GABAergique de l'alcool sur les circuits c\u00e9r\u00e9belleux hyperactifs. Cependant, certains patients d\u00e9veloppent une d\u00e9pendance \u00e0 l'alcool en utilisant cette propri\u00e9t\u00e9 comme autom\u00e9dication de leur tremblement \u2014 ce risque doit \u00eatre explicitement abord\u00e9 lors de la consultation. L'am\u00e9lioration par l'alcool ne signifie pas que le patient doit boire pour contr\u00f4ler son tremblement \u2014 des traitements m\u00e9dicamenteux efficaces existent.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin ou un neurologue si un tremblement des mains ou de la t\u00eate g\u00eane les activit\u00e9s quotidiennes (\u00e9criture + manger + boire) + s'aggrave progressivement + ou s'accompagne d'autres signes neurologiques (rigidit\u00e9 + lenteur des mouvements + d\u00e9s\u00e9quilibre) \u2014 un examen neurologique permettra de distinguer le tremblement essentiel de la maladie de Parkinson + d'une dysfonction thyro\u00efdienne + ou d'un effet m\u00e9dicamenteux. Pour la prescription du propranolol ou de la primidone et l'orientation vers la neurologie, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron distinguent cliniquement le tremblement essentiel du tremblement parkinsonien + du tremblement physiologique accentu\u00e9 + et des autres causes de tremblement, prescrivent le bilan initial (TSH + glyc\u00e9mie + r\u00e9vision m\u00e9dicamenteuse), initient le traitement par propranolol LP ou primidone en titration progressive selon le profil du patient, orientent vers la neurologie pour les formes s\u00e9v\u00e8res r\u00e9fractaires pouvant b\u00e9n\u00e9ficier du DBS ou du MRgFUS, et assurent le suivi de la tol\u00e9rance aux traitements et de l'\u00e9volution. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un neurologue. Le propranolol ne doit jamais \u00eatre arr\u00eat\u00e9 brutalement \u2014 une r\u00e9duction progressive est obligatoire. L'am\u00e9lioration du tremblement par l'alcool ne doit pas \u00eatre utilis\u00e9e comme autom\u00e9dication \u2014 des traitements m\u00e9dicamenteux efficaces sont disponibles et le risque de d\u00e9pendance \u00e0 l'alcool est r\u00e9el dans cette population.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Tremblement essentiel : diagnostic, propranolol et traitement | Clinique Omicron Neurologie & M\u00e9decine de famille & G\u00e9riatrie Tremblement essentiel Le tremblement essentiel (TE) est le trouble du mouvement le plus fr\u00e9quent chez l’adulte \u2014 affectant 0,9 % de la population g\u00e9n\u00e9rale + et jusqu’\u00e0 4\u20135 % des personnes de plus de 65 ans \u2014 caract\u00e9ris\u00e9… <a href=\"https:\/\/cliniqueomicron.ca\/en\/tremblement-essentiel\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Essential tremor: diagnosis, propranolol and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Tremblement essentiel | Brossard | Clinique Omicron","_metasync_otto_description":"Tremblement essentiel Tremblement essentiel est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Tremblement Essentiel | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Tremblement essentiel Tremblement essentiel est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels...","_metasync_otto_twitter_title":"Tremblement Essentiel | Clinique Omicron","_metasync_otto_twitter_description":"Tremblement essentiel Tremblement essentiel est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Neurologie & M\u00e9decine de famille & G\u00e9riatrie<\/span>\n <h1>Essential tremor<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Le tremblement essentiel (TE) est le trouble du mouvement le plus fr\u00e9quent chez l'adulte \u2014 affectant 0,9 % de la population g\u00e9n\u00e9rale + et jusqu'\u00e0 4\u20135 % des personnes de plus de 65 ans \u2014 caract\u00e9ris\u00e9 par un tremblement bilat\u00e9ral + rythmique + de fr\u00e9quence mod\u00e9r\u00e9e (4\u201312 Hz) + principalement cin\u00e9tique (lors des mouvements volontaires) et postural (lors du maintien d'une posture contre la gravit\u00e9) + touchant le plus souvent les membres sup\u00e9rieurs (mains et avant-bras) + et parfois la t\u00eate (tremblement oui-oui ou non-non) + la voix + le menton \u2014 en l'absence d'autres signes neurologiques (pas de rigidit\u00e9 + pas de bradykin\u00e9sie + pas de signes c\u00e9r\u00e9belleux). Anciennement d\u00e9sign\u00e9 tremblement b\u00e9nin ou tremblement familial (en raison de sa fr\u00e9quente transmission familiale autosomique dominante avec p\u00e9n\u00e9trance variable \u2014 jusqu'\u00e0 50\u201370 % des cas sont familiaux), le terme \u00abb\u00e9nin\u00bb est d\u00e9sormais abandonn\u00e9 car le tremblement essentiel peut \u00eatre tr\u00e8s invalidant dans ses formes s\u00e9v\u00e8res \u2014 g\u00eanant l'\u00e9criture + la manipulation d'ustensiles + la boisson dans un verre + les activit\u00e9s professionnelles + et entra\u00eenant un isolement social significatif. La physiopathologie implique une d\u00e9r\u00e9gulation des circuits c\u00e9r\u00e9bello-thalamo-corticaux \u2014 avec une hyperactivit\u00e9 oscillatoire du cervelet + du noyau dentel\u00e9 + et du thalamus ventral interm\u00e9diaire (VIM) \u2014 expliquant pourquoi la stimulation c\u00e9r\u00e9brale profonde (DBS) ciblant le VIM + ou la thalamotomie focalis\u00e9e (ultrasons focalis\u00e9s guid\u00e9s par IRM \u2014 MRgFUS) ont une efficacit\u00e9 remarquable dans les formes r\u00e9fractaires. Le tremblement essentiel se distingue du tremblement parkinsonien principalement par son caract\u00e8re cin\u00e9tique et postural (vs de repos dans la maladie de Parkinson) + l'absence de signes parkinsoniens associ\u00e9s + et sa r\u00e9ponse \u00e0 l'alcool (r\u00e9duction temporaire souvent rapport\u00e9e par les patients) + et aux b\u00eatabloquants.\n <\/div>\n\n <h2>Caract\u00e9ristiques cliniques et distinction du tremblement parkinsonien<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Characteristic<\/th>\n <th>Essential tremor<\/th>\n <th>Parkinsonian tremor<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Type of tremor<\/td>\n <td>Cin\u00e9tique (pendant le mouvement) + postural (maintien de la posture) ++ \u2014 s'aggrave lors de l'action<\/td>\n <td>De repos (au repos, dispara\u00eet lors du mouvement volontaire) ++ \u2014 \u00abpill-rolling\u00bb<\/td>\n <\/tr>\n <tr>\n <td>Frequency<\/td>\n <td>4\u201312 Hz (plus rapide)<\/td>\n <td>3\u20136 Hz (plus lent)<\/td>\n <\/tr>\n <tr>\n <td>Location<\/td>\n <td>Mains + avant-bras bilat\u00e9raux ++ + t\u00eate + voix + menton<\/td>\n <td>Mains +++ + membres inf\u00e9rieurs + menton \u2014 asym\u00e9trique au d\u00e9but<\/td>\n <\/tr>\n <tr>\n <td>Sym\u00e9trie<\/td>\n <td>Bilat\u00e9ral et sym\u00e9trique d\u00e8s le d\u00e9but<\/td>\n <td>Unilat\u00e9ral au d\u00e9but \u2192 bilat\u00e9ral plus tardif<\/td>\n <\/tr>\n <tr>\n <td>Signes associ\u00e9s<\/td>\n <td>AUCUN signe neurologique associ\u00e9 (pas de rigidit\u00e9 + pas de bradykin\u00e9sie + pas de signe pyramidal)<\/td>\n <td>Rigidit\u00e9 + bradykin\u00e9sie + instabilit\u00e9 posturale + hypomimie + micrographie<\/td>\n <\/tr>\n <tr>\n <td>Effet de l'alcool<\/td>\n <td>Am\u00e9lioration temporaire dans 50\u201370 % des cas (crit\u00e8re diagnostique informel)<\/td>\n <td>Peu ou pas d'effet de l'alcool<\/td>\n <\/tr>\n <tr>\n <td>\u00c9criture<\/td>\n <td>Grande \u00e9criture irr\u00e9guli\u00e8re + trembl\u00e9e (macrographie tremblante)<\/td>\n <td>Petite \u00e9criture serr\u00e9e + trembl\u00e9e (micrographie)<\/td>\n <\/tr>\n <tr>\n <td>Family history<\/td>\n <td>Fr\u00e9quente (50\u201370 % \u2014 autosomique dominant)<\/td>\n <td>Moins fr\u00e9quente (10\u201315 % \u2014 formes g\u00e9n\u00e9tiques)<\/td>\n <\/tr>\n <tr>\n <td>R\u00e9ponse \u00e0 la l\u00e9vodopa<\/td>\n <td>Absent or minimal<\/td>\n <td>Excellente (crit\u00e8re diagnostique de la maladie de Parkinson)<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Causes de tremblements \u00e0 distinguer du tremblement essentiel<\/h2>\n <ul class=\"co-list\">\n <li><strong>Tremblement physiologique accentu\u00e9 :<\/strong> anxi\u00e9t\u00e9 + stress + caf\u00e9 + m\u00e9dicaments (caf\u00e9ine + bronchodilatateurs \u03b22 + lithium + valproate + amiodarone + antid\u00e9presseurs + cortico\u00efdes) + hyperthyro\u00efdie + hypoglyc\u00e9mie + sevrage alcoolique \u2192 tremblement postural rapide (> 8 Hz) + fin + r\u00e9versible \u2192 bilan TSH + glyc\u00e9mie + r\u00e9vision m\u00e9dicamenteuse<\/li>\n <li><strong>Parkinson's disease:<\/strong> asymmetric resting tremor + rigidity + bradykinesia + flexed posture + small-step gait \u2192 DaTscan (dopaminergic SPECT) if diagnostic doubt exists<\/li>\n <li><strong>Tremblement c\u00e9r\u00e9belleux :<\/strong> intention tremor (worsens as target approaches) + dysmetria + ataxia + nystagmus \u2192 MS + cerebellar atrophy + alcoholism + drugs (phenytoin)<\/li>\n <li><strong>Orthostatic tremor :<\/strong> lower limb tremor on standing \u2192 high frequency (13-18 Hz) + disappears on walking or sitting \u2192 diagnosis by surface EMG<\/li>\n <li><strong>Dystonic tremor :<\/strong> irregular tremor associated with dystonic posture + head tilt in spasmodic torticollis<\/li>\n <li><strong>Wilson's disease :<\/strong> young adult + tremor (often winged) + hepatic + psychiatric signs + Kayser-Fleischer ring \u2192 cupremia + ceruloplasmin<\/li>\n <\/ul>\n\n <h2>Pharmacological treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Propranolol (traitement de premi\u00e8re ligne) :<\/strong> non-selective beta-blocker + 20-320 mg\/d (progressive titration) + LP forms available (40-160 mg\/d in one dose) + 50-70 % reduction in tremor + mechanism: peripheral blockade of muscle \u03b22 receptors + possible central mechanism + contraindications : severe asthma + severe COPD + AVB + bradycardia + decompensated heart failure + insulin-dependent diabetes (masks hypoglycemia) + side effects: fatigue + bradycardia + hypotension + bronchospasm + erectile dysfunction + DO NOT stop abruptly (risk of rebound)<\/li>\n <li><strong>Primidone (traitement de premi\u00e8re ligne) :<\/strong> antiepileptic \u2192 metabolized into phenobarbital + reduction of tremor by 50-70 % + start at very low doses (12.5-25 mg at bedtime) \u2192 very slow titration (every 1-2 weeks) to avoid initial side effects + effective dose: 50-750 mg\/d in 2-3 doses + side effects: sedation (especially in early stages) + dizziness + nausea + ataxia + physical dependence + do not stop abruptly (risk of convulsions)<\/li>\n <li><strong>Propranolol + primidone combination:<\/strong> superior efficacy to each drug alone in moderate to severe forms<\/li>\n <li><strong>Topiramate :<\/strong> 25-200 mg\/d \u2192 moderate efficacy + useful if propranolol and primidone insufficient or poorly tolerated + side effects: cognitive problems (words on the tip of the tongue) + weight loss + nephro-lithiasis<\/li>\n <li><strong>Gabapentin :<\/strong> 300-3,600 mg\/d + more limited data + useful as an alternative or in combination<\/li>\n <li><strong>Benzodiaz\u00e9pines (clonaz\u00e9pam + alprazolam) :<\/strong> modest antitrembling effect + but useful in occasional stress situations aggravating tremor (presentation + meeting + meal) + risk of dependence + not recommended as long-term background treatment<\/li>\n <li><strong>Botulinum toxin injection:<\/strong> forearm muscles (hand tremor) + sternocleidomastoid muscles (head tremor) \u2192 efficacy 50-70 % + duration 3-4 months + side effects: muscle weakness + particularly useful for cephalic and vocal tremor<\/li>\n <\/ul>\n\n <h2>Traitement chirurgical \u2014 formes s\u00e9v\u00e8res r\u00e9fractaires<\/h2>\n <ul class=\"co-list\">\n <li><strong>Stimulation c\u00e9r\u00e9brale profonde (DBS \u2014 Deep Brain Stimulation) du VIM thalamique :<\/strong> implantation of electrodes in the ventral intermediate nucleus (VIM) of the thalamus + continuous electrical stimulation \u2192 interruption of pathological oscillations + reduction of tremor by 80-90 % + reversible + adjustable + bilateral possible + risks: infection + intracerebral hemorrhage + dysarthria (bilateral) + generator complication<\/li>\n <li><strong>Thalamotomie par ultrasons focalis\u00e9s guid\u00e9s par IRM (MRgFUS \u2014 Exablate) :<\/strong> focal thermal destruction of VIM by ultrasound + without surgical opening + under real-time MRI + efficacy 80-90 % + advantage: non-invasive + immediate + permanent + disadvantage: unilateral only (risk of dysarthria if bilateral) + irreversible + available in Quebec (CHU)<\/li>\n <li><strong>Gamma-knife (radiochirurgie st\u00e9r\u00e9otaxique) :<\/strong> thalamotomy by targeted irradiation + delayed effect (3-6 months) + risk of permanent adverse effect (neurological deficit)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>L'am\u00e9lioration du tremblement essentiel par l'alcool \u2014 rapport\u00e9e par 50 \u00e0 70 % des patients \u2014 est un crit\u00e8re diagnostique informel classique mais cliniquement important. Ce ph\u00e9nom\u00e8ne r\u00e9sulte de l'action GABAergique de l'alcool sur les circuits c\u00e9r\u00e9belleux hyperactifs. Cependant, certains patients d\u00e9veloppent une d\u00e9pendance \u00e0 l'alcool en utilisant cette propri\u00e9t\u00e9 comme autom\u00e9dication de leur tremblement \u2014 ce risque doit \u00eatre explicitement abord\u00e9 lors de la consultation. L'am\u00e9lioration par l'alcool ne signifie pas que le patient doit boire pour contr\u00f4ler son tremblement \u2014 des traitements m\u00e9dicamenteux efficaces existent.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin ou un neurologue si un tremblement des mains ou de la t\u00eate g\u00eane les activit\u00e9s quotidiennes (\u00e9criture + manger + boire) + s'aggrave progressivement + ou s'accompagne d'autres signes neurologiques (rigidit\u00e9 + lenteur des mouvements + d\u00e9s\u00e9quilibre) \u2014 un examen neurologique permettra de distinguer le tremblement essentiel de la maladie de Parkinson + d'une dysfonction thyro\u00efdienne + ou d'un effet m\u00e9dicamenteux. Pour la prescription du propranolol ou de la primidone et l'orientation vers la neurologie, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron distinguent cliniquement le tremblement essentiel du tremblement parkinsonien + du tremblement physiologique accentu\u00e9 + et des autres causes de tremblement, prescrivent le bilan initial (TSH + glyc\u00e9mie + r\u00e9vision m\u00e9dicamenteuse), initient le traitement par propranolol LP ou primidone en titration progressive selon le profil du patient, orientent vers la neurologie pour les formes s\u00e9v\u00e8res r\u00e9fractaires pouvant b\u00e9n\u00e9ficier du DBS ou du MRgFUS, et assurent le suivi de la tol\u00e9rance aux traitements et de l'\u00e9volution. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin ou d'un neurologue. Le propranolol ne doit jamais \u00eatre arr\u00eat\u00e9 brutalement \u2014 une r\u00e9duction progressive est obligatoire. L'am\u00e9lioration du tremblement par l'alcool ne doit pas \u00eatre utilis\u00e9e comme autom\u00e9dication \u2014 des traitements m\u00e9dicamenteux efficaces sont disponibles et le risque de d\u00e9pendance \u00e0 l'alcool est r\u00e9el dans cette population.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Tremblement essentiel : diagnostic, propranolol et traitement | Clinique Omicron Neurologie & M\u00e9decine de famille & G\u00e9riatrie Tremblement essentiel Le tremblement essentiel (TE) est le trouble du mouvement le plus fr\u00e9quent chez l’adulte \u2014 affectant 0,9 % de la population g\u00e9n\u00e9rale + et jusqu’\u00e0 4\u20135 % des personnes de plus de 65 ans \u2014 caract\u00e9ris\u00e9… <a href=\"https:\/\/cliniqueomicron.ca\/en\/tremblement-essentiel\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Essential tremor: diagnosis, propranolol and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Tremblement essentiel | Brossard | Clinique Omicron","_metasync_otto_description":"Tremblement essentiel Tremblement essentiel est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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