Inland Northwest Research

A neurologist is able to examine the tremor and confirm if this is caused by essential tremor or Parkinson’s disease and answer your questions about the tremor. The goal of working with your doctor regarding tremor is to understand the cause and know if and when you need to have it treated, and how to do so safely and in a way that really makes a difference.

There are two to three medications that are very useful to treat ET. Propranolol and primidone are very commonly used to treat ET. When prescribed correctly and monitored closely the use of these medication often results in 50% or more reduction in the severity of the tremor. There are other medications that may be useful if those are not a good fit. A newer device called the Cala Trio is a bracelet that may be warn and reduces the severity of the tremor. Since this is just newly released, most insurance companies do not cover the Cala Trio just yet. For more severe or bothersome cases of ET that do not respond to medication, we are very fortunate to have advanced treatment options.

The options to treat more advanced ET are concerned with targeting a specific part of the brain called the thalamus that has developed a bad electrical signal. Think of the “rabbit ears” antenna on televisions; when there was static, adjusting the antenna gave a clear signal. This is a similar idea for how treating the thalamus, deep within the brain, makes the brain electrical signal more “normal” and relieves the tremor.

Deep brain stimulation is the most commonly used treatment for essential tremor. This involves a specialized neurosurgeon implanting a very thin wire deep into the brain, in the thalamus, and connecting this wire to a small pacemaker device below the collarbone. This device is hidden completely under the skin and no one (not even you!) can see it. After the neurosurgeon puts in the device, a neurologist turns on the device, then quickly programs the settings and it starts working immediately. For some patients who are not medically safe enough to undergo deep brain stimulation, we have options to use a radiation beam (Gamma Knife) or focused ultrasound to burn a very small hole precisely in the brain that results in normal electrical signal in the brain to improve tremor. The radiation and the ultrasound treatments have the advantage of no device implanted into the body, and they both do work well. However, for some patients the tremor can worsen and using the deep brain stimulator is often a better choice because this treatment can have the settings adjusted to keep up with the tremor.

The bottom line is that if you or someone you know is bothered by a tremor you should ask for help! It is important to know the cause of tremor and there are many safe and effective ways to live with tremor which can improve your life Jamie joined Selkirk Neurology in 2018 after serving as lead neurology nurse practitioner at Northwest Neurological for almost 20 years. She is as an advanced registered nurse practitioner in clinic and has achieved national recognition for her work in the programming and management of DBS patients, working closely with the care team of the Spokane DBS Program in collaboration with Dr. John Carlson MD, PhD of Providence Medical Center and Selkirk provider and movement disorder specialist Dr. Jason Aldred. She travels around the nation educating providers about DBS programming and care management for DBS patients. She is dedicated to speaking with patient groups interested in exploring DBS as a treatment option. Jamie graduated from the Intercollegiate Center for Nursing (INC) in Spokane where she obtained her bachelor of science in nursing and registered nursing degrees. She later went on to receive her masters of science of nursing and advanced nurse practitioner degree from the same institution. She is a dedicated provider of quality neurological care and her patients greatly enjoy her knowledgable and amiable approach in addressing their needs. Jamie is currently on the Parkinson’s Resource Center of Spokane’s board of directors and is a former board member of the local Alzheimer’s Association chapter.

Dr. Aldred, co-founder of Selkirk Neurology in Spokane, is a board-certified neurologist and Fellow of the American Academy of Neurology (FAAN). He completed neurology residency at Oregon Health & Science University (OHSU), serving as neurology chief resident. He then completed an additional two-year clinical research fellowship in Parkinson’s disease and movement disorders at the Parkinson’s Disease Research, Educational, and Clinical Center (PADRECC), a collaborative program between the Portland VA and OHSU. Dr. Aldred also completed formal training in clinical research through the Human Investigators Program (HIP) at OHSU focused on design and execution of clinical trials. Dr. Aldred provides diagnosis and treatment for all neurological conditions, with a special interest in Parkinson’s disease and other movement disorders. He conducts clinical trials for a variety of neurological disorders through funding sponsored by the National Institutes of Health (NIH), Patient Centered Outcomes Research Initiative (PCORI), as well as other sources. These research activities are conducted through Inland Northwest Research, a collaboration between providers and trained staff currently integrated into the Selkirk Neurology clinic.

Why Seek an Elder Law Attorney?

by Rebecca Eyman, Partner, Coyle & Eyman Elder Law

In my practice as an elder law attorney, the first question many clients ask is, “Why should I hire an elder law attorney?” Finding the right attorney and paying for legal services can be an ordeal. Disclosing private financial information and discussing death and incapacity can be uncomfortable. Many people would prefer to resolve estate planning issues on their own and avoid the chore and expense of hiring a lawyer. But is that truly wise?

The simplest reason why consulting with an elder law attorney is a good idea is because you just don’t know what you don’t know. Your family’s situation may seem straightforward to you, but pitfalls likely exist that you would never see coming until it’s too late. Elder law attorneys can offer insight into the many elements that make up a comprehensive estate plan, including estate planning documents, financial and tax planning, and planning for incapacity. For this reason, taking advantage of an elder law attorney’s experience and expertise can save you money and hassle down the line.

For example, I often hear from my clients that, rather than preparing and funding a revocable living trust, they would prefer to put one of their children’s names on the deed to their real property. In their minds, this is an easy way for their families to avoid the probate process after they die. If you were to add one of your children to the title of your home, the arrangement could work, however, there are likely to be several negative unforeseen consequences. Most immediately, you would likely

The expense associated with meeting with an estate planning attorney, in the long run, will far outweigh the expense of solving unforeseen legal problems down the line.