Essential Tremor

INTRODUCTION

Essential Tremor: Essential tremor (ET) is a neurological condition where an individual experiences uncontrollable and involuntary shaking that can affect almost any part of the body including hands, head, voice, arms and legs.

Comparison of spiral drawing between individual with essential tremor and healthy control

ESSENTIAL TREMOR

Essential tremor is a neurological disorder that causes involuntary shaking or trembling in different parts and sides of the body.

A theory suggests that the cerebellum, controlling muscle coordination, is not communicating correctly with other parts of the brain.

The cause of this illness remains unknown however, genetics are strongly suspected as one of the main causes.

SYMPTOMS

The voluntary muscles that are consciously moved are affected
Nodding of the head if the head is affected
If the larynx or voice box is affected, a shaky and quivering voice can be detected
A small and rapid tremor
Tremor that is worsened by an activity or movement
Tremor that stops or lessens when the certain body part affected is at rest
Tremor that stops when asleep
Tremor that increases as one gets older
Most of the time, the hands, head and voice are affected
Other parts of the body such as arms and eyelids might also be affected with time

WHAT CAUSES THE DISEASE?

Summary of the four proposed pathophysiology of essential tremor

Four main pathophysiologies of essential tremor have been proposed:

Exposure to environmental β-carboline alkaloids and the consequent olivocerebellar hyper-excitation
Deficiency in cerebellar GABA
Climbing of fiber synaptic pathology with related cerebellar oscillatory activity
Extra-cerebellar oscillatory activity

According to diagram 2, A is the climbing fiber overgrowth and hyperinnervation.

Reduction of GluRδ2 protein in the Purkinje cells causes climbing fiber synaptic pruning deficits, which lead to hypersynchrony and excessive oscillations in Purkinje cells
B is the increased inferior olive automaticity and synchrony
β-carboline alkaloids, such as harmaline, lead to augmented T-type calcium channel function and potentially increased inferior olive synchrony via gap junctions
C and D depicts GABA dysregulation
GABA receptor knockout in Purkinje cells and reduced GABA receptors in the deep cerebellar nucleus can lead to abnormal oscillations in the circuitry

CURRENT TREATMENTS

Medications and injections currently used to treat essential tremor:

Medication	Function	Limitation
Beta Blockers	Beta blockers such as propranolol help relieve tremors	Not a good option for individuals with asthma or certain heart problems Side effects may include fatigue, lightheadedness or heart problems
Anti-Seizures	Epilepsy drugs may be effective in individuals who don't respond to beta blockers Other medications that might be prescribed include gabapentin and topiramate	Side effects include drowsiness and nausea, which usually disappear within a short time
Tranquilizers	Benzodiazepine drugs such as clonazepam may be used to treat individuals whose tension or anxiety worsens tremors	Side effects can include fatigue or mild sedation Should be used with caution because they can be habit-forming
Botox Injections	Might be useful in treating some types of tremors, especially head and voice tremors One injection can improve tremors for up to three months at a time	If used to treat hand tremors, it can cause weakness in the fingers If used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing

Nerve stimulation devices:

A wearable electronic peripheral nerve stimulation device is a newer form of treatment option for people with essential tremor
The device that can be worn works by stimulating peripheral nerves and muscles to create a muscle response that reduces tremors. Studies have found that the device can bring some improvement for tremors
Limitations of the new nerve stimulation device is that it takes too long for only small improvements to show

Surgery:

Deep brain stimulation
Focused ultrasound thalamotomy
Disadvantages of surgeries are the risks of complications and the costly procedures

Therapy is also one of the treatment options to treat essential tremor:

Physical therapy is where exercises are taught in order to increase muscle strength, coordination and control
Occupational therapy provides devices to help an individual with essential tremor adapt and reduce its effects
Disadvantages of therapy include only improving the symptoms of essential tremors and not targeting the root of the cause

WHAT WE OFFER?

EXOSOME THERAPY - CELLTIX

CelltiX is an extracted communicating vesicle derived from Umbilical Cord Derived Mesenchymal Stem Cells (MSCs). CelltiX is prepared in our state-of-the-art cGMP facility.

CelltiX is a new type of major paracrine factor released by MSCs into a culture medium playing an important function in a multitude of biological processes.

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STEM CELL THERAPY - CELLTIMAX

CelltiMax is Mesenchymal Stem Cells (MSCs) derived from human umbilical cords. Upon treatment, the cultured cells are injected intramuscularly / intravenously into the patient.

The cells are characterized by low immunogenicity. Hence, it is very safe, tolerable, and free of side effects. It has the capability to differentiate into specialized cells with specific functions for many parts of the body. They can reduce inflammation, repair, renew, regenerate, and replace damaged cells.

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COMPARISON BETWEEN STEM CELL EXOSOMES

Criterias	Stem Cells	Exosomes
Definitions	Stem cells are unspecialized cells of the human body	Extracellular vesicles, which is the medical term for tiny bubbles that are released from stem cells
Function	Unique, can become any type of cell, and they act as both building blocks and repair mechanisms in your body	Carry genetic information and proteins to cells throughout your body, and they create paths for communication between cells
Origins	Donor stem cells are placed in your body and are guided into becoming specific cells in the body to replace and repair diseased cells	Exosomes are extracted from donated human mesenchymal stem cells (MSCs) and sterilized
Growth Factors	Less amount of growth factors compared to exosomes	Exosomes contain nearly three times the amount of growth factors. More growth factors mean a better ability to restore and revitalize target cells
Administration	IV Stem Cell Therapy (Intravenous administration) Intrathecal (directly into the spinal canal) Site injections into problem areas (Knee, hips, hands, etc)	Intravenous (IV) therapy Direct injection in the treatment area

BENEFITS OF OUR TREATMENTS

Stem Cell Therapy	Exosome Therapy
Improve bodies' natural healing abilities	High stabililty
Modulate the immune system	Low toxicity and immunogenicity
Locate and reduce areas of inflammation	High penetration
Replace damaged and diseased cells	Enhanced delivery efficiency

HOW IT WORKS?

STEM CELL THERAPY (CELLTIMAX)

How stem cells can help decrease and repair damages caused by neurodegenerative diseases

Previous studies on stem cells have shown that the effects of stem cells on endogenous cells include:

Promotion of functional recovery of nervous tissue,
differentiation into neuronal and glial cells,
Reduction of motor impairments.

These cells can develop into neural progenitor cells (NPCs) and mesenchymal stem cells (MSCs), from which brain cells of various neuronal and glial lineages, including oligodendrocytes and astrocytes, can be produced.

EXOSOME THERAPY (CELLTIX)

Illustration of an exosome as well as its characteristic that aid in essential tremor treatment

Exosomes function as tiny messengers that provide vital genetic data, proteins, and messenger RNA to cells throughout our body. They aid in information transmission between cells and improve cell communication.

It has been demonstrated that exosomes from youthful stem cells can rejuvenate older stem cells in our bodies, help control a hyperactive immune system, and modify the immune system so that it works more efficiently and cogently. Because of its anti-inflammatory and immunomodulating properties, exosome treatment has been proven to be helpful for treating essential tremors.

TALK TO US

If you feel we might be able to offer meaningful improvement to both your condition and your quality of life, then please reach out to schedule a free consultation with one of our in-house clinical experts. We offer consultations in both Malay and English.