Essential Tremor Treatment with Multi-Modal Nutritional Therapy: A Case Study of a Teenage Patient

Despite many years of ET research, its pathophysiology remains unknown. Essential tremor (ET) is common and frequently affects quality of life. The case outlines a safe and novel approach to ET treatment that can either be trialed in treatment-refractory cases or used in tandem with traditional therapy. Although traditional pharmacotherapy is sometimes effective, patient factors, lack of efficacy, and poor adherence sometimes limit its efficacy. Furthermore, the pathophysiology of ET is not fully understood, but it is increasingly regarded as a highly heterogeneous disorder of cerebellar pathways underpinned by low gamma-aminobutyric acid (GABA) tone. This knowledge and review of recent data prompted the development of a multi-modal nutritional therapy approach to target three putative ET pathways: (i) diet (specifically adopting a Mediterranean diet); (ii) GABA tone (through oral supplementation); and (iii) L-tryptophan/vitamin B pathways (Triptobel oral supplement). The approach is illustrated here with the case of a 13-year-old boy with ET causing severe functional impairment. A full history revealed no exposure to toxins and there was no family history of ET or other movement disorders. He was prescribed a sugar-free, Mediterranean-style diet rich in whole grains as a carbohydrate source and rich in vegetables, fruit, olive oil, and fish. After two months of therapy, his tremor decreased significantly and he regained normal function. In conclusion, ET is a common disorder that affects quality of life and is often treatment-refractory. The case identifies and highlights several areas worthy of further investigation, particularly with respect to establishing the role of oral GABA and vitamin B/tryptophan supplementation in ET. Given the safety and positive health benefits of this novel nutritional therapy approach, it can be trialed in patients with ET either with or without concurrent traditional pharmacotherapy.