Essential Tremor in India: Shaking Up Our Understanding

Dr. Sagar Betai

Do your hands ever shake when you're trying to do something precise, like thread a needle or sign your name? For most of us, a little trembling here and there is no big deal. But for the millions of Indians living with essential tremor, those shakes can make even simple tasks feel impossible.

What is Essential Tremor?

Essential tremor (ET) is a neurological disorder that causes rhythmic shaking, usually in the hands, arms, head, voice, or legs. It's often confused with Parkinson's disease, but they're actually quite different. While Parkinson's tremors usually happen when the body is at rest, essential tremors fire up when you try to do something, like lift a glass of water or tie your shoelaces.

ET isn't life-threatening on its own, but it can seriously impact quality of life. Imagine trying to eat soup with a shaky spoon, or sign a check with wobbly hands. For some, the tremors are so severe that they can barely write, use a phone, or get dressed without help.

Who Gets Essential Tremor?

Here's the thing - essential tremor is pretty common. Worldwide, it's the most prevalent movement disorder, affecting millions of people of all ages. While exact numbers for India are hard to pin down, some estimates suggest that ET may impact up to 10 million Indians to some degree.

And get this: about half of all cases are thought to be inherited. If one of your parents has a gene mutation linked to ET, you've got a 50-50 shot of inheriting it yourself. So if shaky hands run in your family, it's worth paying attention to.

Living with Essential Tremor in India

For many Indians with ET, daily life can be a challenge. The constant shaking can make it tough to work, socialize, or even take care of basic needs. Some people feel embarrassed or self-conscious about their tremors, leading them to withdraw from friends and family.

There's also the financial burden to consider. While India is a world leader in medical tourism, offering high-quality, affordable healthcare to international patients, the reality for many Indians is quite different.

According to World Bank data, the top 10% of Indians hold a whopping 57% of the country's wealth. Meanwhile, the per capita income hovers around just 2.4 lakh rupees (about $2,700) per year. So for the average Indian, paying for ET treatment on top of regular expenses can feel next to impossible.

The Cost of Treatment

Speaking of treatment, let's talk options. There's no cure for essential tremor (yet), but there are ways to manage symptoms and improve quality of life. The main treatments available in India include:

• Medications: Drugs like propranolol, primidone, and gabapentin can help reduce tremors for some people. But they can also cause side effects like fatigue, dizziness, and cognitive issues.
• Botox injections: Botulinum toxin shots can temporarily weaken overactive muscles and ease tremors. But they're expensive, need to be repeated every few months, and can sometimes cause muscle weakness and pain. Plus, there's a risk of the body developing resistance over time.
• Deep brain stimulation (DBS) surgery: This involves implanting electrodes in the brain to interrupt faulty nerve signals. It can be very effective for severe tremors, but it's a major procedure with risks like infection and stroke. The device alone can cost upwards of 22-23 lakh rupees - almost ten times the average annual income in India.
• MRI-guided focused ultrasound: This newer treatment uses sound waves to target overactive brain cells without cutting into the skull. It's less invasive than DBS, but still costly. A single session can run around 30 lakh rupees, putting it out of reach for most Indians.

The bottom line? For many in India, getting proper treatment for essential tremor is a luxury they simply can't afford. The result is countless people suffering in silence, unable to access the care they need to live full, productive lives.

Finding Hope

But it's not all doom and gloom. In recent years, Indian doctors and researchers have been working hard to improve access to ET care and develop more affordable treatment options. While there's still a long way to go, their efforts are starting to bear fruit.

One area of promise is non-invasive brain stimulation techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These use magnetic fields or mild electrical currents to temporarily alter brain activity and reduce tremors. While not a permanent fix, they're generally safer and cheaper than surgery.

Researchers are also exploring novel drug targets and delivery methods to make medications more effective with fewer side effects. Some are even looking into natural compounds like caffeine and nicotine, which have shown potential for reducing tremors in early studies.

The Road Ahead

As India continues to grapple with the challenges of essential tremor, it's clear that we need a multifaceted approach. That means:

• Spreading awareness and education about ET, so people can recognize symptoms and seek help early on
• Investing in research and development to find better, more affordable treatments
• Strengthening healthcare infrastructure so quality care is available to all, not just the elite
• Providing financial support and resources to help patients access existing treatments
• Tackling the root causes of health disparities, like poverty and lack of access

It won't be easy, but it's a fight worth fighting. No one should have to suffer in silence or go broke just to keep their hands steady. By working together and thinking creatively, we can shake up the status quo and build a future where every Indian with essential tremor can thrive.