Tremor is an unintentional, rhythmic to and fro muscle movements in one or more parts of the body. It is the most common form of involuntary movement. Most commonly tremors occur in hands. Tremors are not life threatening, but they can be embarrassing to some people.
What are the causes?
Neurological disorders like multiple sclerosis, stroke and traumatic brain injury.
Neurodegenerative diseases that damage or destroy parts of brain.
Some drugs like amphetamine, steroids and drugs used in psychiatric disorders.
Alcohol abuse or withdrawal
Hyper functioning thyroid
Some types of tremors are inherited
What are the characteristics of tremor?
Rhythmic shaking in hands and other parts of the body
Difficulty in writing or drawing
Difficulty in holding objects
May be triggered by stress, anxiety or following physical exhaustion.
Can occur in any age group but common in elderly
What are the types of tremor?
Resting tremor: occurs during rest and when all muscles are relaxed. Seen in Parkinson’s disease.
Active tremor: occurs during activity.
Postural tremor: position against gravity
Kinetic tremor: during movements of the body
Intention tremor: during a purposeful movement
Task specific tremor: when performing highly skilled tasks.
Categories of tremors:
Essential tremors: commonest form. Hands are most often affected. Head tremor may also occur, called yes-yes or no-no tremor. Stress, high fever, physical exhaustion or low sugar may trigger these tremors. These tremors can sometimes run in the family. They may be associated with cerebellar degeneration.
Parkinsonian tremor: this occurs at rest and is due to damage to certain parts of the brain that control movement. Sometimes it can also appear as action tremor. Classically it is seen as pill rolling movement.
Dystonic tremor: Dystonia is a movement disorder in which sustained involuntary muscle contractions cause twisting and repetitive movements. These movements are painful. Dystonic tremors occur when the patients is in certain posture. These occur irregularly and are relieved by rest
Cerebellar tremor: It is a slow tremor and occurs at the end of a purposeful movement. Also called intention tremors these cerebellar tremors are caused by stroke, tumor, multiple sclerosis or some inherited disorders. It also occurs in chronic alcoholism. They are accompanied by speech problems and gait disturbances.
Psychogenic tremor: also called functional tremor they are associated with stress. They disappear when the patient is distracted.
Orthostatic tremor: occurs in legs on standing. They disappear when the patient sits or starts walking.
Physiologic tremor: seen in normal individuals due to stress, anxiety, physical exhaustion, hypoglycemia, alcohol withdrawal and fever. They are not caused by any neurological disorder.
A proper clinical history and a detailed neurological examination.
MRI brain to rule out any structural lesions.
Electromyography to see for any involuntary muscle activity.
There is no definite cure
For psychogenic tremor treat the underlying psychological problem
Anti Parkinson’s medication for Parkinson’s tremor
Propranolol and other beta blockers for essential tremors
Clonazepam for dystonic tremors
No medication for cerebellar tremor
Surgery: deep brain stimulation is the most common form of surgical treatment. Electrodes are implanted to send high frequency electrical signals to certain parts of the brain. A battery-operated device called neuro stimulator is used to deliver the electrical stimulation. This method is used to treat tremor due to Parkinson’s disease, dystonia and essential tremors.