Austin, 

I came on here to research this exact thing. Have you tried the dry needling yet?

My patient has 20+ history of essential tremors who has only been seen by a primary care physician. I am discussing with patient about seeing a neurologist to rule in/out Parkinsons as she does have a pill rolling type tremor at rest. 

I have needled my patient twice. Initially, I educated patient on dry needling and the benefit of it but kept it pretty basic and MSK focused into the distal forearm/hand where patient has tremors the worst. I wasn't expecting much change in tremors with needling distally, however I used it mainly for an introduction to TDN. 

The second time I needled into the cervical spine C2-C7 as well as I could, bilateral dorsal scapular homeostatic points, bilateral spinal accessory homeostatic points, deep radial homeostatic points, and superficial radial homeostatic points. I wanted to needle lateral pectoral however I was unable to get to the area with my patient's clothing and I didn't have enough time to have her change. Pt attached the tens unit to the deep radial and superficial radial homeostatic points for 5 minutes but next time I think I would like to do superficial radial and one of the cervical segments. 

I took the foundational course with the instructor Nina who had needled her dad who has Parkinson's I was going to reach out to her to see if she had any suggestions on essential tremors. 

Hi Austin!

I have treated two patients with essential tremors. I focused on the paravertebral points and distal homeostatic (superficial/deep radial/antibrachial cutaneous) with estim.  Followed up with functional activities to promote proper motor patterns. 

I saw improvements in my patient’s peg hole test and penmanship after the first two sessions. 

She required needling 1x a week for maintenance as her symptoms returned to baseline without needling. She moved a month after we started, so I don’t have a long term follow up.   

Our instructor, Nina, has been doing some case studies on patients with PD and can probably offer more helpful insite! 

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.

hope that helps!

Nina