Myokymia/familial tremor

[JST327]

I have for many years experienced continous muscle twitch (myokymia?) in my calves, along with benign familial tremor.  I tried propanolal for several years, which decreased the severity of both problems.  Unfortunately, the respitory side-effects from the medicine forced me to discontinue it.

Any suggestions on different medications that I might try?  Also any thoughts on someone somewhere specializing in myokymia?

Thank you.

[sanbart]

Dr. Chahine......I, too, have been diagnosed w/essential tremors.  I have taken Inderal 60 LA for several years and it does help, but the tremors have gotten more intense over the years. (I am a 70 yr old female).  I have tried to take mysoline and it knocked me out, so no more of that.  Would increasing the dosage of Inderal help?  Thank you

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is nor can I recommend specific therapies for you. However I will try to provide you with some useful information on Benign Essential Tremor (BET) and its treatment.

As you mention, propranolol is a commonly used and effective treatment for BET, but can not be used in people with asthma and some other pulmonary problems.

Other treatments for BET include primidone, or mysoline. The main side effect is sedation and it can cause allergic reaction in some people. Topamax is another medication used, its main side effect is cognitive slowing (it makes you think sort of slowly) but this improves with time and can be minimized by slowly going up on the dose. Other medications that have been tried and work include selective beta-blockers (similar to propranolol, but works selectively on more specific receptors, so that lung issues are less of a problem), and neurontin, which is useful but can cause sedation and weight gain

Most medication have one side effect or another but in the treatment of BET, they have been successful for most patients. When the tremor becomes debilitating and starts affecting daily life and occupation, there are surgical options available (called deep brain stimulation, which at this time is only done in a few centers in the world but seems highly effective).

Essential tremor is hereditary (it runs in families). The good news about it is that besides the tremor, which is of course very bothersome to some people, it does not have other consequences (it is not neurodegenerative) in the majority of patients, though a minority develop parkinson’s disease.

I recommend continued follow-up with your doctor. It is important for you to discuss all your questions and concerns with him/her and find a treatment regiment that you are comfortable with and that is effective.

Thank you for using the forum, I hope you find this information useful, good luck.