Alcohol & Essential Tremor

hey everyone good evening welcome to I care for your brain with board-certified neuropsychologist dr. Karen Sullivan that's me every Wednesday night at 6 o'clock we try to meet here for science-based education and empowerment tonight we are going to be returning to essential tremor and tonight's focus is going to be on the relationship to alcohol I think this is my fifth lecture on essential tremor and I want you all to know how much I truly enjoy researching these topics I really appreciate how much love and support you all have shown me as a community it is really become one of my most beloved brain health challenges because there's so little information out there and it really exemplifies my whole mission which is to reduce the unnecessary suffering that goes along with brain health challenges that comes from simply not knowing enough not having good enough quality information and not having your symptoms validated I can't even imagine how maddening that would be to have a syndrome where only one aspect of the disease or the disorder was visible noticeable to other people and people simply thought that was the total story that that was my total experience well we know with everything that unfortunately isn't working well in the brain that there's many more things that happen cognitively and there's many more things that happen emotionally so et to me has really become this quintessential brain health challenge that really exemplifies those things so just to take a general step back I know a lot of you are watching who have et and you don't need me to go through all these statistics but I always like to kind of start at a basic level and build up et is the most common movement disorder worldwide we have 10 million of you out there who are living in this brain everyday but yet so little beyond that tremor is known so little is under-researched in the literature so little is undervalued by most medical providers and therefore we have a whole a lot of et that is under treated and I think you will join with me in agreeing that this is unacceptable we have about twenty different subtypes of tremor and that even within a subtype you can have more subtypes so a tremor can happen and hands can head the middle of the body your voice your legs really anywhere in the body all too often people with tremor are simply put into the category of having tremor okay about thirty to fifty percent of you with ET have been on a diagnostic journey before you actually settled on ET proper so thirty to fifty percent of you have been misdiagnosed in the past possibly are being misdiagnosed now most people there's a very thin line between dystonia essential tremor and Parkinson's so a lot of people kind of live in that area we also know that tremor can exist on its own but much more common it is a part of a broader syndrome so people can have tremor due to stroke traumatic brain injury multiple sclerosis but they can also have it as a result of things like overactive thyroid anxiety mercury poisoning liver failure certain types of medications anything that we know has a steroid affect things like inhalers and fetta means caffeine anything that can kind of speed you up can also mimic trip tremor we also know that alcohol is intimately related to tremor and that's why we really wanted to make sure that we get those two things in a discussion together when we're talking about tremor there's two different ways that I typically think of them so we have your resting tremor and then we have your action tremor and the resting tremor we know happens when the muscles are relaxed so this is think of your hands kind of resting on your lap so this is the type of tremor that's most often seen in Parkinson's and typically it happens in one side of the hand sometimes the leg first it typically generalizes throughout the whole body over time but that's one of the soft signs we use to differentiate PD from ET is is it happening on one side of the body or not within the world of action tremor this is where et typically lives and with in action tremor which is what happens when we're voluntarily moving a muscle this is called an intention tremor most typically so this is produced with purposeful movement so I want you to think about as the person gets closer to their target this is really when the shaking or the tremor can begin and this is because of the part of the brain that is responsible for the tremor in essential tremor which is the cerebellum and in a lot of my lectures I've hopefully helped you understand the role of the cerebellum for decades it was very much classified as the balance center of the brain the coordination center of the brain and yes it probably does that primarily but we also know that it has connections to cognitive parts of the brain specifically the frontal lobes and two parietal parts of the brain related to spatial awareness it has connections to the memory center and the emotional centers of the brain so thank God we are coming leaps and bounds in recognizing that this part of the brain has many many tasks and if you have a disorder that is centered in this part of the brain you are going to have symptoms in all three of those systems physical which we can see the tremor cognitive and emotional so why it's so important to talk about all of this stuff again to me goes back to validation so the reason that that is so critical is because so many of you who are out there when you have these inevitable other symptoms start to really question is this part of my et is there something wrong with me am I getting dementia am I going crazy and that's part of what we've done in these lecture series on 80 is really trying to help you understand the cerebellum so let's just imagine that you are reaching for a pen okay the process of the cerebellum kicking in is really when you almost are ready to grab the target okay so your hand is over here and you got a big old movement cerebellum not necessarily that interested it's right when you start to reach reach reach for that target that's when the Sarah kicks in that's why when I see patients in my office one of the things when we're thinking about the cerebellum that we can do is asking folks to put their hands out and I simply want them to touch their nose with their pointer finger so usually people with Parkinson's are having a hard time here and as they get closer to the nose and they start to rely more on the cerebellum it actually gets goes from shaky here to smoother here with cerebellar issues are et it's the exact opposite so typically we see pretty smooth here okay here okay here and as you start to get to the nose you start to see the shake so you can absolutely see that on yourself if you do that in the mirror so I want you to remember that the cerebellum isn't just the coordinator of those fine movements motorically as we get to a target it is the great coordinator of everything that your brain does it coordinates your word finding it coordinates your eye movements it coordinates your emotions the way you express yourself okay coordinates the way you walk and this is really what we think of as the cerebellar syndrome so it's not going to just be something related to a tremor okay so in the world of research for ET we've made progress in knowing okay it's focused here in the cerebellum but actually in the last few years we've gotten even more focused and we know that the real issue with ET is based in a type of specialized cell called the Purkinje cells and believe me eventually we're gonna tie this to alcohol but we have to talk about the Purkinje cells because that's how this all is going to make sense so what we think is that in the cerebellum what's happening over time is that people are losing these very specialized cells called Purkinje cells okay so there was research starting in about 2007 that basically looked at people's brains who had passed on after you know living a nice long healthy life but they happen to have et and in about 75% of them they actually weighed the cerebellum and they found that these folks had a lot less weight to this part of their brain because their loss of these Purkinje cells okay the reason that this is so important and how it relates to alcohol is what the per can g-cells do Purkinje cells release a neurotransmitter chemical called gaba gaba is the critical word in our conversation tonight this is gamma-aminobutyric acid we're just gonna call it gaba and in 2012 they really started to get more and more clear about what exactly these Purkinje cells do and how they relate to gaba so again they started looking into the people's brains who had passed away who happened to have et and what they were really starting to find is that these folks specifically had very little gaba in their brain and we know that the medications that help with tremor n80 are typically helping us with gaba so there's a very close relationship between those two things so Purkinje cells almost all of them release GABA now the big question is what does gaba do gaba is basically the breaks in our brain it has a very strong inhibitory control over different parts of the brain specifically in the cerebellum it basically stops any type of activity in the brain so it stops you from speaking when you don't think you should when it's not appropriate it stops your hand from moving when you don't want it to it stops your eyes when they want to focus on a specific object and altogether starting and stopping is a big part of what the cerebellum does remember that's essentially coordination something be I think of it like the gas pedal in the brake pedal I've said that before so you have to have excitatory action in the brain to start a movement to start a thought to start an emotion but it's very important that you have the inhibition too and you're able to actually stop these things and that really is what a tremor is it's difficulty with starting and stopping in some ways it's really as simple as that so when you think about Purkinje cells i want you to understand how beautiful these things are they're very very very very complicated kind of shaped like a flask there's so many different extensions of these specialized cells but they all come down into a very very thin single axon that means they are grabbing information from so many different sources but they're funneling them down into one long chemical messenger to the next brain cell our Purkinje cell is only about 80 microns in diameter so I want you to just wrap your head around that that's how teeny these things are the human eye cannot see anything smaller than 40 microns so 80 microns we think is about the cross-section of a piece of human hair so imagine take a little piece of your hair might be a little bit gray like mine from quarantine and imagine that about that size is the size of the Purkinje cell this is what is responsible we think for the symptoms of ET through a very complicated and synchronized activity this is how your Purkinje cells work okay they're very very much a coordinated concert now there is one chemical that Purkinje cells are more sensitive to than any other cell in the human brain and I bet some of you are smart enough to start figuring out what that agent is it is alcohol I promised you we were going to get to the combination of these two things soon so we've known for a long time that alcohol can hurt the cerebellum and specifically the Purkinje cells this is really what goes wrong when fetuses are exposed to high levels of alcohol during embryonic growth this is how we people get fetal alcohol syndrome we know that people who become alcoholics over time if you scan their brain with a CT or an MRI they have smaller cerebellums okay one study in 2004 looked at people who are chronic alcoholics and the number of Purkinje cells in their cerebellum was decreased by about 25% so we know that et is a progressive condition and what we now know it's because folks with ET unfortunately are losing Purkinje cells meaning they are having less and less inhibition of gaba so the reason we're talking about this tonight is because you need to understand how alcohol affects the brain the cerebellum the Purkinje cells and gaba not so that you can never have a drink again this is not going to be a buzzkill of a lecture this is not gonna be like don't you this it goes along with my whole philosophy which is I simply want you to be informed so you can make well-reasoned decisions for yourself and the solution actually isn't to cut off a relationship with alcohol it's to simply manage it a little bit better knowing your specific risk factor of having et so one of the things I was surprised about when I started doing this research is how little I mean nothing there is out there about ET and alcohol so the reason that I was surprised by that is because we are all doing the best we can in any given moment okay remember I am a neuropsychologist so the brain is very important to me but the word psychologist is even bigger in my title I care more about the person than I do the brain right and believing people are doing the very best they can we have to see that it's very logical that someone with the tremor that is helped by alcohol would gravitate towards alcohol so it's a natural attraction a natural magnetic relationship if you had a tea and especially if alcohol works to want to use it in a therapeutic way but there are dangers and I want you to know about them so about 80 percent of people who have ET if they drank about a pint of beer or one small glass of wine within about 15 minutes they would get a relief from their tremor and that relief can last anywhere from an hour to four hours okay this is such a robust research finding that doctors actually ask questions about alcohol many of you have probably gotten these questions or even in a neurological clinic you can sometimes be given alcohol to see if you have a tremor suppression and that's actually used diagnostically to diagnose ET separate from say PD or dystonia this is especially the case if you are someone who has a younger onset of your ET meaning you were less than 40 years old when you started to have symptoms so you're going to be more responsive to alcohol than someone who developed it later in life so what are the positives of alcohol and ET well you get less grammar you can function better and you have less social stigma that is one of the things we're always talking about here too again going back to the human focus of what we do it is hard to be a person in the world with any chronic disability seen or unseen and so I know many of you have struggled with people's perception of you having a tremor so often people can feel embarrassed and then they limit their socialization because of that so it's a big issue so of course there's downsides to alcohol we all know this right well with et specifically you are at risk for even worse what they call rebound tremor so what this mean is as the alcohol wears off the tremor kind of comes back the next day a little bit harder a little bit stronger which of course makes you want to chase it with more alcohol you can become more and more tolerant to alcohol over times which means you need more and more over time to suppress the tremor at the same level you did previous alcohol really doesn't work for very long so it's a very short term solution heavy drinking over a period of time really does make people depressed it's a central nervous system depressant so it can really really do a job on your mental health we also know alcohol affects our judgment and it can really affect relationships alcohol is the most commonly used substance in all of adulthood and especially it matters once we get older just simply because of the aging process but also the medications that we take as we get older so if you're over 60 about 50% of men and 37% of women drink regularly so we hear a lot about alcoholism alcoholics that's actually not my biggest concern there's actually another type of drinking because it's more common that is more worrisome to me and something we need to talk about and this is called at-risk drinking this is those of us who think we don't drink too much we don't need it when we get up I don't need an eye-opener you know I can go a day or two without a drink but the truth is you're probably drinking a little bit too much for good brain health and this is defined as more than three drinks on one occasion or more than seven in a week okay this does more harm to people than alcoholism alcohol disorders as we get older our liver and our kidney start to not function as well and this is where we process alcohol so basically a little bit of alcohol affects us a lot more as we get older it also of course can exacerbate underlying medical conditions can make you have your heart beat can skip hypertension heart attacks stroke your immune system goes down your bone density goes down your hearing actually gets worse your vision actually gets worse when you're under the influence of alcohol it slows down the way you think it slows down your reaction time you become less coordinated your speech gets Lurie you can lose your balance there's so many different things that alcohol does besides just suppress your tremor that might actually if you were to take a step back be making your overall functioning not that great alcohol dependence actually cuts your lifespan by about 12 years that is pretty significant now the good news the good news is that it takes about 20 years of pretty heavy drinking to result in brain damage okay so I always use that with my patients if you drank three or more drinks on average per day for about twenty years you will get cerebellar damage now why is that important to you smarty pants you already know that it's because you already have a risk factor for cell death in the cerebellum so you don't need something else on top of that adding fuel to the fire do you I don't think so mixing alcohol with prescription medicine is very very dangerous and especially those of you out there with et there's four different medications that you're likely to be prescribed that are known to be even fatal when mixed with alcohol so we have to talk about those the first one are beta blockers so this is things like per Pannalal alcohol can have an impact of how much of this drug stays in your system you can have changes in your heart rate or your blood pressure when combined per panel all with alcohol next one or any kind of benzodiazepine xanax alprazolam klonopin these things combining them with alcohol is definitely deadly in high doses again because your central nervous system can become depressed and you can die in your sleep your brainstem won't be able to sustain your basic life functions neurontin also known as gabapentin this can also depress your central nervous system topamax is another one a lot of you take and again you can have depression mental status changes so we want to really be mindful of those things now of course as I was saying before we know that we can get a mood lift too after we drink we can have a sense of euphoria we can be more social it can calm us and it's very easy to rely on alcohol because it's just the glass away so we have to talk about other ways that we can use to positively cope so the way alcohol has its positive effects is that it increases the effects of gaba so here we've got the Purkinje cells that are involved with gaba and now we know that alcohol also affects the Purkinje cells via gaba so again we are suppressing momentarily the central nervous system with the alcohol that's why you get the tremor benefit but over time that imbalance is not healthy so one of the things that I became interested in this is a slight side note I all this talk about gaba really made me think about gabapentin again I know I just mentioned that but I was like has anyone in the et community really explored gabapentin if gaba is too little gaba is related to ET well let's give gabapentin doesn't that kind of make sense well it's not as easy as that gabapentin is very structurally similar to the neurotransmitter gaba it does penetrate the blood-brain barrier so you take it via pill and it actually can get into the brain but it is not converted metabolically into gaba so basically there's a lot of research that shows it's about as effective propanolol and it has a type b level of evidence from the American Academy of Neurology and their guidelines for essential tremor and basically in conclusion just enhancing GABA through a pill is probably much too easy of a solution to the et problem we know yes that Purkinje cell loss is related to ET but it's not going to be simply fixed by just putting more gaba into the brain unfortunately so what should your personal relationship to alcohol be well first of all take your ET out of it and just think of yourself as a human being and remember that alcohol affects different people differently so I want you to think about your different factors that influence how and to what extent alcohol might be affecting your brain so of course how much you drink and how often you drink really matters at what age you first began drinking how long have you been drinking what is your age what is your gender I'm gonna tell you why US women are at greater risk in a minute what's your genetic background do you have any family history of alcoholism okay women are more vulnerable to men than for many of the physical medical consequences of alcohol so for example alcoholic women develop liver disease faster than men they develop damage to the heart muscle car cardiomyopathy faster they get peripheral neuropathy faster and we also know that they have greater brain shrinkage than men so this is important right so that becomes a risk factor so okay I'm a woman my uncle was an alcoholic okay you know did your mother drink while she was pregnant with you do you have any issues in your cerebellum okay well I have essential tremor now we've got a new risk factor okay so you have to make this decision for yourself personally and that's part of why we're here right is we want you to be able to be more educated and more informed like I said before it's very important that we take age into consideration and so the guidelines from the American geriatric Society in the National Institute of Alcohol Abuse and Alcoholism tell us that as we get older you really should never be drinking more than three in a sitting and we want to stay under that seven per week there's also very strong evidence that if you have a family history of Alzheimer's disease that when you drink a fair amount that you're three times more likely to have those Alzheimer's disease genes expressed within you so again that's another important thing that I want you to know if you can't cut back on your own and you have et and you've developed drinking as a coping mechanism over time I really want to help you not feel shameful about that again you know you do as well as you can until you know better so once we talk about how many drinks you know it's healthy to have in a week of course I have to talk about size because some of you get very creative with your cups so one standard drink is a 12 ounce beer a 5 ounce wine or 1.5 ounces of hard alcohol so now you know some of the risks you know some of the benefits where can you make changes well these are my recommendations I want you to be conscious of your relationship to alcohol and I really think it's best if you're listening to this and you have et to think of using it sparingly I don't want every decision that you make in life to surround your ety believe it or not as a neuropsychologist as I've said before you are the most important thing one aspect of you is that you have et but we also don't want to deprive you 100% of things that give this human life pleasure so you can use alcohol in my opinion on special occasions you can use it when you really feel like it's important to your quality of life to relax let's say you're at a wedding and you just don't want to shake and you want to be able to feel like you could just blend in and you're sick and tired of standing out and asking having people ask you questions I really don't think there's anything wrong with knowing how you can exploit the positive impact of alcohol on your et I really think that that's okay the problem is when we become dependent or over time if we need more and more to get that same effect one question you might have is well what kind of alcohol would you recommend and a lot of people go to red wine now I want to tell you this quick story red wine does have a slight benefit over other alcohols because of the photo nutrients the color especially red wine but the truth is a lot of that research has been really exploited and all alcohol is interpreted by the brain as ethanol and ethanol is beer it's vodka it's white claw its wine its beer whatever you like to drink I personally think that's what you should drink it's it's about quality of life and happiness but again it's all about moderation so I hope that this information makes you feel more informed it's definitely a personal decision and if you don't know better you can't do better right so I am so excited to tell you this next thing so quarantine has really been working on me and I'm very much bitching to do some kind of a broader project and like I said at the beginning of this talk the et community has just loved on me so much and I have grown to really really be connected to you all and just really want to do everything I can to support you all and so I was speaking with one of your wonderful leaders Jackie Farrell and I told her you know what what would you think if I did a virtual conference on essential tremor I have a wonderful colleague dr. Jenna Renfro who some of you know she's been here twice with us talking about very important things and she is a movement disorder specialist and I feel very good about talking about et at this point what if we just did a zoom virtual conference and just started putting together some lecture topics so that's what we're gonna do and we're going to do it on June 26th it's going to be four hours worth of programming with me and dr. Jenna Renfro and we have decided that we're really gonna focus on are the motor symptoms in ET all the stuff that doesn't get nearly enough time with your doctors but you know darn well is happening within you the registration is going to open in early June we're working right now to figure out the topics and how we're gonna actually pull it off but we will by God June 26 and what I'd love you to all do is message me here on Facebook with your email if you want to be notified when we open up the registration I'm really excited I have wanted to do virtual conferences for a really long time but you know when life is happening at its normal pace it is kind of hard for me to fit new things in with everything I have going on but I'm trying to find the silver linings in quarantine I am trying to figure out new and innovative ways of connecting with people and helping my chosen community which is all of you out there so we will work really hard to keep it as affordable as possible and I you we are so enthusiastic to find information that will not only inform you but I am so dedicated to this idea of empowering you and I know that that happens when you just understand your condition better so if you think that that would be an important contribution and that you would like to join us please just give me a little heart or a little thumbs up or something I I really appreciate all of the support that you guys send my way so please share this video I hope that it feels like an important contribution to your encyclopedia on ET I am so honored to be here with you really I mean that from the bottom of my heart so I can't wait to see you guys again and I'll talk to you soon bye bye

Channel: I CARE FOR YOUR BRAIN with DR. SULLIVAN

Views: 91,710

Keywords: i care for your brain, dr karen d sullivan, brain health, brain, tremor, alcohol, essential tremor

Id: LC-_vtX4wDs

Length: 29min 45sec (1785 seconds)

Published: Sun May 10 2020