Tremors and involuntary shaking can be alarming, whether you experience them yourself or notice them in someone you care for.
Tremors are involuntary, rhythmic muscle contractions resulting in shaking movements in one or more body parts.
Most people experience occasional tremors, which are often brought on by tiredness, stress, or anxiety. However, persistent or severe tremors may indicate an underlying neurologic condition.
Types of Tremors
There are two main types of tremors: Action Tremors and Rest Tremors.1 Tremors are categorized based on when and how they are activated. Within each, there are multiple subcategories.
- Action tremors occur when a muscle is intentionally moved.
- Rest tremors occur when a body part is completely relaxed. People with Parkinson’s disease often experience rest tremors.
“Tremors shouldn’t be accepted or ignored, as they can be a symptom of various neurologic conditions. A thorough assessment is essential to arrive at an accurate diagnosis.”
Cooper and Inspira Neuroscience
Some of the most common forms of tremors include:2
- Essential tremor: Essential tremor (previously also called familial tremor) is one of the most common movement disorders. Its key feature is a tremor in both hands and arms during action without other neurological signs. It also may affect a person’s head, voice, or lower limbs.
- Parkinsonian tremor: Parkinsonian tremor is one of the first signs of Parkinson’s disease, although not all people with Parkinson’s disease have tremors. Shaking is most noticeable when the hands are at rest. Parkinson’s tremor may also affect the chin, lips, face, and legs.
- Functional tremor: Also referred to as psychogenic tremor. Symptoms start suddenly and fluctuate widely. The tremor may increase with attention to it and decrease when the person is distracted.
- Cerebellar tremor: Caused by damage to the cerebellum, which is at the base of the brain and is responsible for maintaining balance, posture, and muscle tone. Damage may be from stroke or tumor, related to an underlying disease, inherited disorder, or from chronic alcohol abuse.
- Enhanced physiologic tremor: Experienced as a small action tremor in both the hands and fingers. Generally, it is not caused by a neurological disease. It may be result of drug reaction, alcohol withdrawal, or medical conditions like an overactive thyroid or low blood sugar.
- Dystonic tremor: Dystonic tremor occurs in people who are affected by dystonia—a movement disorder in which incorrect messages from the brain cause muscles to be overactive, resulting in abnormal postures or sustained, unwanted movements.
How Tremors Are Diagnosed
Diagnosing the cause of tremors involves several steps and tests:3
- Medical History: Your doctor will ask about your symptoms. They’ll want to know what medications you’re taking. They’ll also want to know any relevant family history. Some types of tremors can run in families.
- Physical Examination: Your doctor will perform a thorough physical exam. They’ll test for muscle tone, strength, reflexes, balance, and speech.
- Lab Tests: Blood tests can rule out metabolic causes like thyroid disease. Urinalysis can detect toxins that may cause tremors.
- Diagnostic Imaging: Imaging may be ordered to help identify any underlying cause.
- An MRI of the brain can help determine if the tremor is caused by brain damage.
- An electromyogram, which measures involuntary muscle activity and muscle response to nerve stimulation, can help identify muscle or nerve issues.
“Early intervention can significantly improve the quality of life for individuals experiencing tremors. With the right treatments and lifestyle changes, patients can continue to live full and productive lives”
Cooper and Inspira Neuroscience
Treatment Options for Tremors
Several treatments can help reduce the frequency and severity of tremors. The recommended treatment or combination of treatments depends on the type, related cause, and severity of the tremors.
Medications1
- Beta-blockers: Used to treat essential tremors and other types of action tremors.
- Anti-seizure medications: Effective in suppressing essential tremors for some who are not responsive to Beta-blockers.
- Dopaminergic Medications: Commonly prescribed for Parkinsonian tremors and other movement issues related to Parkinson’s disease.
- Botulinum toxin: Useful in treating some types of dystonic head and hand tremors.
Surgery1
- Deep Brain Stimulation (DBS): DBS may be recommended if the patient is not responding to medications. DBS uses a neurostimulation device — like a heart pacemaker — to deliver electrical pulses to a very precise location in the brain that influences symptoms.
- Ablation: An ablation is a surgical procedure used to treat tremors by destroying a tiny area in the part of the brain that is causing tremors.
- Ultrasound: Focused ultrasound is a noninvasive method of treating tremors (usually for Parkinson’s disease) when medicines do not help. High-frequency sound waves guided by magnetic resonance imaging (MRI) destroy very specific areas in the brain that cause abnormal body movements.
Lifestyle Changes1
- Avoid Caffeine: Caffeine and other stimulants can increase tremors.
- Limit Alcohol Consumption: Alcohol may temporarily reduce tremors, but they tend to worsen once the effects of alcohol fade. Over time, larger amounts of alcohol will be needed to alleviate tremors.
- Relax: Stress and anxiety can exacerbate tremors. Relaxation techniques, such as massage, yoga, or meditation, effectively help reduce stress.
- Change How You Do Things: Whenever possible, use the hand that is less affected by tremors when performing daily tasks.
- Take Medications on Time: Consult a doctor about discontinuing any medications that might be contributing to the tremor.
- Get Enough Sleep: Some tremors worsen when a person is tired.
Understanding the types and causes of tremors is the first step toward effective management. Consult with a medical professional if you or a loved one is experiencing persistent or severe tremors.
References
- National Institute of Neurological Disorders and Stroke https://www.ninds.nih.gov/health-information/disorders/tremor[↩][↩][↩][↩]
- Medline Plus. A quick guide to understanding tremor https://magazine.medlineplus.gov/article/a-quick-guide-to-understanding-tremor/[↩]
- Medical News Today. Causes and treatments for body tremors https://www.medicalnewstoday.com/articles/body-tremors
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