Krishna Anand

HST ISM-7
Annotated Bibliography

Burke, Deborah A. "Essential Tremor. Practice Essentials, Background, Etiology. N.p., 23 June
2015. Web. 28 Sept. 2015.

Essential tremors are a disorder that is found in over 40% of neurological patients.
The source of this disorder has still not been identified.
Suspicion of early onset tremors are often easily misdiagnosed as Parkinsons or
Alzheimers, both of which are rare diseases with fatal symptoms.
The presence of Alzheimers or Parkinsons can be confirmed in a magnetic resonance
imaging, or MRI.
These diseases can also be confirmed in a head computerized tomography scan (CT
scan).
Essential Tremors is mono-symptomatic, meaning that the only symptom of the disorder
is the tremor.
Tremors can usually be found solely looking at the family history
They can also be found when examining the patient.
If there is a suspicion of early onset tremors, a magnetic resonance imaging (MRI) should
be ordered.
Primidone and propranolol are the drugs used to reduce the tremor.
For some patients, the tremor is so negligible that the simply consumption of a little
alcohol prior to a social event solves the problem.

This source went in-depth in understanding how and why essential tremors occur and how it can
easily be misdiagnosed with Alzheimers disease or Parkinsons disease, which gives me a better
understanding on how I can impact others who do not understand the difference between
essential tremors and Alzheimers disease (the first audience targeted in my product).

Krishna Anand
HST ISM-7

Louis, Elan D. "Essential Tremors: Emerging Views of a Common Disorder." Nature.com.

Nature Publishing Group, 13 July 2006. Web. 14 Oct. 2015.

The most common neurological disorders among adults.

It has been shown that it passes genetically.
Defined as a mono-symptomatic, a single symptom disorder characterized by a
kinetic arm tremor, when the patient moves the arm.
Is often misdiagnosed with the disorder Parkinsons.
There is nothing that can cure it, but there is medicine that can keep its effects at a
minimum.
The mortality rate for this disease has NEVER been studied.
Essential tremors occur greatly in white- communities, as shown by surveys.
A certain form of Lewy Bodies makes essential tremors distinctive from a normal
brain, and there are certain parts of the brain that are specifically affected by the
tremors.
Kinetic Tremor- Tremor occurring with physical movement- is the most common
type of tremor.
Rest tremor occurs in about 1/5 Tremor patients and it occurs when the limb is
stationary against gravity.
Rest tremor is another name for diseases like Parkinsons disease and Alzheimers
disease.
There are many areas of study regarding this disease so it is hard to examine this
disorder as a whole.

This source was useful as it validated the information from the previous article that I will use to
support the first hypothetical case in my product, which is informing the public of essential
tremors and the difference between essential tremors and life-threatening diseases such as
Parkinsons disease.

Krishna Anand
HST ISM-7

Richardson, Dr. "Deep Brain Stimulation for Movement Disorders." Deep Brain Stimulation for
Movement Disorders. Pittsburgh University, n.d. Web. 19 Oct. 2015.

Deep Brain Stimulation (DBS) can be used once tremors have become unbearable and
the shaking caused by the tremors is very extreme.
Risks consist of a 2% chance of bleeding in the brain which may cause a stroke and 5%
chance of infection.
Requires a neurological follow-up every 3-4 years to examine the effectiveness of the
DBS.
Average of the decrease of tremor in the patients is 80%.
If the patient has had other disorders in the past (stroke, traumatic brain injury) they less
likely to benefit from DBS.
Often, if medication has side-effects on patients that are unbearable, then the Deep Brain
Stimulation surgery is recommended.
This is conducted by placing a thin metal electrode onto several locations in the brain and
sends an electric shock to the different parts of the brain.
The patient is awake when the surgery is being conducted to test the brain activity
resulting in the appearance or disappearance of the tremors.
This is known as Micro-Electro guided Deep Brain Stimulation.
This has only recently become a viable solution to essential tremors as the equipment and
technology required has only recently been developed.

This source was extremely useful in identifying and explaining what exactly Deep Brain
Stimulation is so I can, with a deeper understanding, create the product of a brain under the Deep
Brain Stimulation surgery.

Krishna Anand
HST ISM-7

Cunhoa, John P. "Vertigo: Sample Patient with Symptoms." EMedicineHealth. N.p., 02 Apr.
2014. Web. 05 Oct. 2015.

The patient being discussed in this weeks case study is 52 year old, white female.
Previously, she had been diagnosed with arthritis in her sacroiliac joint (SI joint), a subtle
case of Essential Tremors, Left Ventricular Papilloma, and memory loss.
Additionally, she is not able to handle any more steroids or anti-inflammatories so
another method of treatment must be used.
The main problem at hand is the severity of her vertigo and essential tremors
The two disorders have been closely related and have progressively worsened over time
The patient complains of a shaking in her right hand more intense than previously
diagnosed and is getting severe headaches in her right ear that last anywhere from 4-6
hours at a time.
She says this has been going on for a while and wants to get it checked before it becomes
worse.
The patient recently had a MRI done, which the doctor used to check for brain
abnormalities and the results of the MRI were normal.
When there is nothing detectable on an MRI, and after asking series of questions like if
family members had essential tremors, it is safe to assume that the patient has essential
tremors.
The vertigo was obvious from the start as the symptoms such as pain on one side of the
head and headaches were presented.
The medical treatment for this patient consists of 100 milligrams of Gabapentin, a
medication more commonly used for seizures, but in low doses is effective on tremor
patients and on vertigo patients, 3 times a day.
The hope for this patient is to reduce her tremors and lower the number of headaches she
has per month.
This illustrates how tremors and headaches go hand and hand with each other.
This article is very helpful in identifying how essential tremors work together with other
disorders, and when it is being treated, it can be treated with the same medication to have
multiple effects (lowering headaches and tremor in the patient).

Krishna Anand
HST ISM-7

Jenkins, Mary. "Peripheral Glycerol Injections May Be Helpful in the Treatment of

Idiopathic Trigeminal Neuralgia." Journal of Evidence Based Dental Practice 2.3
(2002): 206. 2003. Web. 04 Oct. 2015.

Gabapentin is a medication that has only recently started being used in clinics.
Originally, this was a seizure medication.
25 patients were diagnosed with extreme essential tremor
Patients were given Gabapentin over a series of two weeks and each patient had different
doses of the medication.
Each patient was also given a one week washout period.
A washout period is the time it takes for the medication to fully exit the human body.
Each patient did not know how much of the dose of the medication they were taking as
some were given placebos.
A placebo is a fake medication so that way if a patient is faking their symptoms or
feelings, they can be identified.
The trial was a success as people who took Gabapentin had a huge decrease in amount of
tremors present in them after the two week period.
This gives a better understanding on how medications that were designed for seizures and
headaches can benefit essential tremors.
While the improvement of each patient could not be quantified, the symptoms could be
qualified thus making the experiment valid.
This source was extremely useful as it helped identify why doctors now heavily
recommend seizure medications to their patients as an alternative to the traditional tremor
medication.