Hi Dan! 

I hope you are well.  Our instructor, Nina, has been performing case studies on individuals with PD. She had answered the question in the past and I have attached her response below! 

I think it's a good call to avoid anywhere that leads may be located.  I'd say if you are looking to manage her tone, focus on the homeostatics as this is a central issue.  For her localized hip pain, you would likely have success with a combination of her homeostatics, paravertebrals, and symptomatics. Nina goes into great detail about this further below! 

"All,

Yes, my needling experience has been primarily with Parkinson’s Patients, thus the effectiveness in an essential tremor patient may vary, albeit both are central nervous system deficits and we know needling influences the CNS. I would recommend focusing on the homeostatics first and foremost across the body. With my patients I tend to stick to deep and superficial radial in extremities (without and with e-stim) and saphenous, common fibular and deep fibular as well as Thoracic and L2/L5. 

I would focus much more so on thoracic (T6/T7) especially due to its secondary influences on the sympathetic nervous system given the sympathetic ganglion are located in this area over going to spinal segment needling. Remember, this person doesn’t have radiculopathy from their cervical spine, it’s inheritantly a CNS deficit, so going local will not give as much benefit as trying to stay global. If you have ample needles to use, after implementing global homeostatics you could include spinal segments related to distribution of tremoring (cervical) and some major homeostatics distally from there like mentioned above. TDN is not going to be as effective for these patients in terms of dulling their tremoring, as it will only likely provide some mobility and pain-relief but will not have as much of the CNS responses as the homeostatics will.

You can also attempt vagal nerve stimulation in the inner ear (I usually attach e-stim for 5-10 mins) I have had great success with this in terms of tremor reduction, BUT you must be clear that the state you live in does NOT exclude this from your practice act. I live in OH, and it is allowed here. That is not the case in some states. I am assuming your tremoring is primarily upper extremity, but just remember the ROOT CAUSE of your deficit and treat that, and not just the symptoms. If there’s needles left in your plan, you can include symptomatic for some pain relief or mobility."

Let me know if you have any further questions!

Natalie