Cooling therapy and tacrolimus induced tremors

By Anna Shavers

Dr. Aparna Wagle Shukla
Dr. Aparna Wagle Shukla

Commonly prescribed to patients undergoing organ transplant surgery, tacrolimus, an immunosuppressant medication, suppresses the immune system to ensure successful organ transplant.

Taking tacrolimus can induce, or cause, an uncontrollable tremor in the arms and hands that impacts the daily lives of patients. Research shows tacrolimus induced tremor affects more than 30-70% of patients.

“When medications cause tremors, we typically have the patient stop or change medications. Because tacrolimus helps patients receiving a lifesaving organ transplant, stopping the medication is not a practical solution,” said Aparna Wagle Shukla, M.D., professor in the Department of Neurology at the University of Florida and a movement disorders specialist at the Norman Fixel Institute for Neurological Diseases at UF Health

Even though tremors caused by tacrolimus may affect more than half of patients, there are even more unknowns related to the characteristics of tacrolimus induced tremor, including the frequency, frequency stability over time and the amplitude of the tremor. Because little is known about tacrolimus induced tremors, there are no definitive therapies for treating these tremors.

In a recent study, researchers at the Norman Fixel Institute for Neurological Diseases aimed to understand the physiological characteristics by conducting a study with patients that developed tacrolimus induced tremors following a kidney transplant surgery.

By reviewing the characteristics of tacrolimus induced tremor, researchers explored what therapy options may be beneficial for reducing or stopping tremors caused by taking tacrolimus.

Utilizing a therapy commonly used for essential tremor and tremors in other disorders, researchers explored the impact cooling therapy had on tacrolimus induced tremor. Researchers placed icepacks on the arms and hands of the patients with tacrolimus induced tremor and found that patients felt relief and could write and feed themselves.

“These findings are important as cooling therapy is noninvasive, easy to implement, and could be recommended to patients on immunosuppressants like tacrolimus,” said Wagle Shukla.

Read the full article in Tremor and Other Hyperkinetic Movements.