November 20, 2014
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Brain Health

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Tremor

Tremor (shaking) is an involuntary repetitive movement that usually affects the hands, but can also affect the feet, legs, head, face and voice. Most people with tremor are healthy, but sometimes tremor can be a symptom of a neurological problem (e.g., Parkinson's disease, stroke) or a side effect of a medication.

In fact, we all have a slight tremor, even if we are unaware of it. This is called "physiological" tremor and can be detected when electronic sensors are placed on the fingertips. Some types of tremor are inherited; for others, no known cause can be found.

There are several kinds of tremor:

  • Resting tremor, as the name implies, occurs when you are at rest, for example when the hands are stationary and the arms relaxed. Resting tremor, notably of the "pill-rolling" type between thumb and fingers, is a common feature of Parkinson's disease. It lessens with use of the hands.
       
  • Postural tremor is the opposite of resting tremor. It comes on when the arms are held in a certain position (e.g., holding arms out in front of you). Included in this category is physiological tremor, and the tremor brought on by certain medications, recreational drugs and alcohol (notably alcohol withdrawal), and drinking too much caffeine. Certain metabolic disorders, including thyroid gland overactivity, can also cause postural tremor.
       
  • Intention tremor is a task-related shakiness of the hands, such as when placing a cup to the lips. "Pure" intention tremor, occurring without postural tremor, is quite uncommon and it can denote a problem with the cerebellum, which is a part of the brain that controls bodily coordination.
       
  • Mixed postural/intention tremor is a type of tremor that is both task-related and related to muscle activation. The usual cause is a medically harmless condition called "essential" tremor, not connected to disease of any sort.

Essential tremor

Essential tremor is the most common tremor. It comes on specifically when using the hands with such activities as writing, holding a newspaper, or putting a fork or a cup to the lips. To steady the cup, two hands may have to be used. It can also produce shakiness of the voice, the lower jaw, or the whole of the head resulting in a nodding "yes" type of tremor, or a sideways "no" movement of the head.

Although essential tremor is medically harmless, it can have significant impact on your emotional health as you may be embarrassed by it or may not be able to perform certain tasks or careers because of it. Career plans may have to be changed, because essential tremor tends to get worse with time and is life-long. It can start as early as childhood or as late as 75 or 80 years old.

In a minority of instances, essential tremor is profoundly severe, even to the point of requiring brain surgery. But for the majority of people, either no treatment is needed or medications can help control the tremor. Medications such as a beta blocker (e.g., propranolol) or primidone may also be used to treat essential tremor.

In about half of instances, essential tremor is inherited and it affects other members of the same family. Causative factors, other than genetic, have not been found. Unlike with Parkinson's disease, there is no actual disease of the brain involved in essential tremor.

If you have a tremor, talk to your doctor. Your doctor will perform a physical examination and order additional tests (e.g., blood work, CT scan, MRI scan) if needed. Also, try to eliminate things that make your tremor worse such as caffeine, stress, fatigue, and smoking.

 Written and reviewed by the MediResource Clinical Team 


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