Tremors
Tremors are involuntary, rhythmic shaking movements of a part of your body, caused by various conditions. To determine the cause and appropriate treatment, it’s essential to first identify the type of tremor. There are two main types: action tremor and rest tremor, each with subcategories defined by specific criteria.
Physiologic tremors are normal reactions to situations, like an arm shaking when held steady for too long. Pathologic tremors are linked to medical conditions, such as Parkinson’s disease.
This article discusses the categories used to identify tremors, their causes, and treatments.
Action Tremors Action tremors occur with intentional muscle movement and have several subtypes:
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Postural Tremor: Occurs when trying to keep a body part still against gravity, such as holding your arms out. Causes include Parkinson’s disease, certain drugs, or essential tremor.
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Isometric Tremor: Happens when muscles tense against a stationary object without movement, like during push-ups or holding a heavy object.
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Kinetic Tremor: Occurs during voluntary movement, with subtypes:
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Task-specific Tremors: Only with specific actions, like writing or speaking.
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Intention Tremors: Most prominent during coordination tasks, worsening near the target.
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Rest Tremors
Rest Tremors Rest tremors happen when a body part is completely relaxed. They are commonly caused by Parkinson’s disease, often affecting different sides of the body with a frequency of 3-6 Hz. Parkinson’s disease rest tremors also include symptoms like reduced blinking, small handwriting, and limb stiffness. Other causes include dystonia and conditions like rubral tremor and Wilson’s disease.
Causes and Treatments Tremors can result from medications, anxiety, or low blood sugar, and conditions like essential tremor, dystonia, or Parkinson’s disease. Treatment focuses on addressing the underlying disorder. Medications, physical therapy, and in severe cases, brain surgery or deep brain stimulation, are options. Treatment should be discussed with a healthcare provider.
Physiologic Tremor Everyone experiences physiologic tremor, usually unnoticed, with low amplitude and high frequency. It can be more noticeable due to anxiety, fatigue, caffeine, fever, alcohol withdrawal, low blood sugar, and certain medications. Enhanced physiological tremor resolves when the cause is corrected.
resolves when the cause is corrected.
Essential Tremor Essential tremor is a neurological movement disorder affecting up to 6% of the population, often starting in adolescence or middle age. It typically causes action tremors, primarily in the hands. Severe cases may involve resting tremors. Treatment options include medications, focused ultrasound, and deep brain stimulation.
Parkinsonism Parkinsonian tremor can be caused by Parkinson’s disease or other neurodegenerative disorders, drugs, infections, and toxins. Treatment may involve medications like levodopa or other dopaminergic drugs.
Psychogenic Tremor Psychogenic tremor has a psychological cause and may disappear when distracted or follow stressful incidents. Treatment includes cognitive behavioral therapy, relaxation techniques, physiotherapy, or transcranial magnetic stimulation.
Orthostatic Tremor
Orthostatic Tremor Orthostatic tremor causes trembling in the legs and trunk upon standing, improving when sitting. Treatment options include clonazepam or primidone.
Drug-Induced Tremor Various medications can cause tremors, including stimulants, corticosteroids, antidepressants, and antipsychotics. A healthcare provider may recommend pausing the suspected medication, but do not stop taking prescriptions without consulting a doctor.
Dystonia Dystonia is a movement disorder with involuntary muscle contractions causing abnormal postures. Treatment often involves botulinum toxin injections and medications like clonazepam or anticholinergics.
Cerebellar Tremor Cerebellar tremor results from damage to the cerebellum and shows up as an intention tremor with high amplitude and low frequency. It commonly affects individuals with multiple sclerosis. Though no FDA-approved medications exist, treatments may include propranolol or amantadine.
Summary Tremors are categorized based on muscle activation into action and rest tremors. Action tremors can be postural, kinetic, or isometric and can occur due to conditions like essential tremor or dystonia. Rest tremors are often linked to Parkinson’s disease. Treatment focuses on the underlying cause, with options including medications, physical therapy, surgery, or deep brain stimulation. Your healthcare provider will recommend a treatment plan based on the severity and cause of your tremor.
FAQs
Tremors are involuntary, rhythmic movements of a part of the body, often the hands, arms, head, or voice. They can result from various conditions such as essential tremor, Parkinson's disease, multiple sclerosis, medication side effects, or alcohol withdrawal. Understanding the underlying cause is crucial for appropriate treatment.
Diagnosis of tremors involves a thorough medical history, physical examination, and sometimes neurological tests to determine the type, severity, and underlying cause. Imaging studies like MRI or CT scans may be used to rule out other conditions contributing to tremors.
Treatment options for tremors depend on their cause and severity. Medications such as beta-blockers, anti-seizure drugs, or botulinum toxin injections may help manage tremors. Physical therapy and lifestyle changes like reducing caffeine intake or managing stress can also be beneficial. In severe cases, surgical interventions such as deep brain stimulation (DBS) may be considered to control tremors effectively.