Ask an expert - neuro and psycho logical - tremors

5 questions

Q:  I read your answer to  another person about shaky hands. The answer is not in a straight forward manner and vague. Please clearly and directly tell that can acupuncture play an effective role in tremor management?. 

 

A:  We are sorry that you found our answer vague.

There are two reasons why we could not say with certainty that acupuncture will be an effective treatment for essential tremor. The most important one, which all of our answers on tremor say, is that Chinese Medicine treats people, not symptoms, and so there are no guaranteed treatments for specific conditions. From our perspective the same symptom could arise in a dozen people and be treated in a dozen different ways. The exact treatments will be geared to the individual, and a great deal will depend on their overall state of health and balance. Clearly a young person with good energy is likely to respond a little more quickly to treatment than someone of 70 years of age who has lived a hard life. However, even that is not a certainty; we have seen patients of 90 who have responded magnificently to treatment.

The other reason that we cannot give a more definite answer is that all advertising and marketing on the internet is now governed by the same restrictions as print media. The Advertising Standards Authority has very strict rules on claims for efficacy, and in healthcare provision the bar has been set at the level of randomised double blind control trials. This criterion of research works well for drug trials but is inappropriate for acupuncture treatment (and surgery!), which is why there is a very small number of problems for which we can make unequivocal claims for efficacy. This is in spite of the fact that there are many thousands of studies which show very positive results.

This is why we are cautious in what we say, but also why we recommend in nearly every case that the best way to find out whether treatment may be beneficial is to visit a local BAcC member for an informal assessment of what may be possible. A practitioner who sees the symptom in the context of the person's overall health is likely to be able to give a much more useful opinion than we can at a distance.

We are sorry if this sounds equally vague.

Q:  I have got multiple sclerosis and a bad intention tremor in my left hand. I was just wondering if you thought acupuncture would help ease my tremor please?

A:  We have to be honest and say that if the intention tremor is a manifestation of the MS and involves irreversible changes in the cerebellum, then from a Western medical perspective there would be little prospect of being able to improve the condition. However, we look at things from an entirely different perspective, and our general approach to problems like this is summed up in an answer we gave some time ago to a question about benign essential tremor as follows:

There are occasions when acupuncture can achieve surprising results, and if you undertake an internet search you will find a case report written up by one the American medical acupuncture practitioners

http://www.medicalacupuncture.org/aama_marf/journal/vol1_1/tremor.html  which outlines a very successful intervention. There is also a paper

http://www.ncbi.nlm.nih.gov/pubmed/20214065 which suggests that acupuncture alongside conventional treatment may be more effective in reducing symptoms. We have to say, however, that these are far from the norm, and benign essential tremor can prove very resistant to treatment.

The point which we also have to emphasise, however, is that Chinese medicine works on the basis of an entirely different conceptual structure from conventional medicine, premised as it is on the understanding of the body as a flow of energy, called 'qi', and what happens when that flow is disrupted or disturbed. This means that symptoms as
they are described by a patient and signs observed by the practitioner are filtered and made sense of within this 'grid', and that can mean on occasion finding an explanation which would not be a part of western medicine thinking at all. Were this to be the case, there may be treatment options which a Chinese medicine practitioner would employ to address the problem as it was defined within this system, and with 2000 years of development and refinement there are going to be occasions where a solution is found which western medicine cannot match. This is still in the realms of 'unlikely', but it would be nonetheless be possible. There is a category in Chinese diagnostics called 'internal wind', for example, which can manfest as shaking and tremors in the limbs, and a fairly direct treatment used to address it.

We could not make this kind of determination remotely, however, and you would need to see a BAcC member local to you and your mother to seek advice on whether there were elements of her condition which lent confidence to a practitioner that there was something they could do. Most members are willing to give up some time without charge to advise prospective patients on the suitability of treatment, and we would recommend this as your best option to get a clearer picture for your mother.

We think that the same point applies here, and mirrors to some extent what we do when we treat people who have recently had strokes. There is undoubtedly damage to brain tissue from the stroke but from a Chinese medicine perspective it is the disruption of the flow of qi in the limbs which generates the spasticity and paralysis as a manifestation of the same energetic problem which has affected the brain. It is not at all uncommon in China for people to have a course of acupuncture treatment starting within hours of the stroke itself to encourage a rapid return to normal flow of qi in the affected limbs.

Our view is that it would certainly do no harm to have a few sessions of treatment, and it may lessen the severity of the symptoms. As we said in the earlier reply, though, this might still be something of a long shot. The most recent review of evidence, however, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086829/

is not altogether negative, concluding that people 'should not assume that acupuncture is not effective in this population but rather that the literature is insufficient to make claims either for or against its use', which in medical research terms is a tacit admission that there may well be something good going on.

Our advice in these kinds of case is always the same. Each individual is unique, and it is, as the great Canadian physician William Osler once said,' more important to find out about the patient who has the disease than the disease the patient has.' It would be useful to have a chat face to face with a local BAcC member to get a clearer assessment. If you did decide to go ahead, we would always advise caution, though, in how many sessions you had. It can be quite easy to get locked into a treatment pattern that carries on for some time with no discernible improvements, so we like to see reviews put in place after every four sessions and try to find clearly measurable outcomes to assess whether there has been any progress.

Q: I have a shaking hand which sometimes affects my voice. The doctor says it is involuntary tremor. Would acupuncture help?

A: We have been asked a similar question in the past about benign essential tremor, and our response then was:

A:  There are occasions when acupuncture can achieve surprising results, and if you undertake an internet search you will find  a case report written up by one the American medical acupunture practitioners

http://www.medicalacupuncture.org/aama_marf/journal/vol1_1/tremor.html

which outlines a very successful intervention. There is also a paper

http://www.ncbi.nlm.nih.gov/pubmed/20214065

which suggests that acupuncture alongside conventional treatment may be more effective in reducing symptoms. We have to say, however, that these are far from the norm, and benign essential tremor can prove very resistant to treatment.

The point which we also have to emphasise, however, is that Chinese medicine works on the basis of an entirely different conceptual structure from conventional medicine, premised as it is on the understanding of the body as a flow of energy, called 'qi', and what happens when that flow is disrupted or disturbed. This means that symptoms as they are described by a patient and signs observed by the practitioner are filtered and made sense of within this 'grid', and that can mean on occasion finding an explanation which would not be a part of western medicine thinking at all. Were this to be the case, there may be treatment options which a Chinese medicine practitioner would employ to address the problem as it was defined within this system, and with 2000 years of development and refinement there are going to be occasions where a solution is found which western medicine cannot match. This is still in the realms of 'unlikely', but it would be nonetheless be possible. There is a category in Chinese diagnostics called 'internal wind', for example, which can manifest as shaking and tremors in the limbs, and a fairly direct treatment used to address it.

We could not make this kind of determination remotely, however, and you would need to see a BAcC member local to you to seek advice on whether this particular presentation of the condition lent confidence to the practitioner that there was something they could do. Most members are willing to give up some time without charge to advise prospective patients on the suitability of treatment, and we would recommend this as your best option to get a clearer picture.

We think that this remains sound advice for your problem. The point we did not make in the earlier reply was that a Chinese medicine practitioner will look at a symptom or group of symptoms in relation to the whole picture. This will mean taking  a detailed case history covering all aspects of someone's health and well-being as well as looking at their medical and personal history. The system of medicine is predicated on the inter-connection of body, mind and spirit, and their inter-actions, so there  are all sorts of aspects of health which a practitioner will try to make sense of. Symptoms rarely just appear, but in conventional medicine there is perhaps less time spent, or able to be spent, looking at the wider picture to see where they might have come from. This is not a criticism; one of the frequent comments about complementary medicine is that it is the time spent with the patient which accounts for some of its success, with conventional practitioners rarely able to spend a long time getting a comprehensive picture.

Q:  have trouble with my hands shaking involuntary and have been issued with blood pressure tablets to take when needed. I find it worse when I am amongst strangers. would acupuncture help?


A:  We are assuming that you have been given a thorough physical and neurological examination, and that the shaking is not a symptom of a wider pattern. If you haven't, then without wishing to sound alarmist, it would be a good idea to ask your doctor for this to be arranged.
 
As you may have realised by looking at our website, acupuncture is based on an entirely different set of principles and theories. The central one is that the body, miond and spirit are all made up of a single energy, called 'qi' in Chinese, whose flow, balance and rhythms are the foundation of good health and functioning. Symptoms which are used in conventional medicine to provide what doctors call a differential diagnosis play the same role in Chinese medicine, except that the background against which they are seen is very different and uses a language which is at one and the same time precise yet sounding strange and even simplistic to the western ear. Symptoms like yours are not new, and when they have appeared over the last two thousand years practitioners of Chinese medicine have used the growing body of knowledge and skill in their tradition to make sense of them. Even when there is no specific pattern to guide their treatment, we must not forget that Chinese medicine in its basic form was less concerned with the symptom than with the overall balance. The belief was, and still is, that the symptom is only an alarm bell, not the problem itself, and the skill of the practitioner lay in putting the whole system in order as best they could.
 
How does this help you? Well, in essence it means that a Chinese medicine practitioner will see your symptom in its wider context, and may be able to find a direct causal link to a pattern of imbalance which might be correctable. There may also be significant areas of imbalance, the treatment of which might correct symptoms. The best advice we can give you is to visit a BAcC member local to you to ask for a brief face to face assessment of what they might be able to do. It is very important with symptoms such as these to be very clear about outcomes and have something which is measurable to assess progress. Conditions like this can come and go to a degree, and if you are spending money on treatment you need to know whether it is working.
 
In this 'expert's' personal view, involuntary shaking can prove quite intractable to acupuncture and not always that responsive to conventional medication. Since beta blockers (on the assumption that this is what you have been given) can have a number of tiresome side effects, you need to be sure that they are having an effect if you are continuing to take them. Since they have been prescribed by your GP you should not stop them without speaking to a doctor first, or at least you should make sure that you have a review period after which you can assess their value. Doctors sometimes need to demonstrate that a patient has gone the full course before they can move to the next stage of examination and treatment.   
 

Q. My wife suffers from Primary Orthostatic Tremor. This is a condition where signals from the brain do not reach the legs correctly, and causes instability when standing still. It does not affect walking. Has any member had experience of treating this condition.

 

A. With over two and a half million treatments being administered by BAcC members every year it is highly likely that someone has been treated for orthostatic tremor or one of a number of similar conditions. Unfortunately, we do not keep a central record system which details all of the problems which members treat, and rely on our own internal networks for information gathering.

 

A common response, however, when a member posts on an internal forum 'has anyone treated x?' is for other members to say, 'don't tell me about the western name for the condition, tell me about the signs and symptoms from a tradtional acupuncture perspective and describe how the problem manifests.' The whole basis or paradigm of chinese medicine is different, with an entirely different understanding of physiology and pathology. There are sometimes occasions where a description of a condition will make sense and offer a prospect of treatment in traditional chinese medicine where in the west it is regarded as permanent and beyond help.

However, this is the sort of statement that has to be made with extreme care, because these occasions are more rare than not, especially where complex chronic conditions which defy western treament are concerned. It is true that Chinese doctors have been treating the same problems for two thousand years under a different name, but equally true that they had their fair share of cases which did not improve.

 

The best course of action is to visit a BAcC member local to you to see what they make of the specific symptoms which present here and whether they have experience of similar presentations and can offer you a view of whether this specific case may be helped. If you do decide to go ahead, it would be essential to set very clear outcomes and review periods from the outset. Conditions such as this usually fluctuate a little, and there is often a will from all sides to see any small improvements as a sign the treatment is working when it is no more than a normal pattern of variation.

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