A tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or happen as a result of another disorder.
- Shaking starts off gradually, usually focusing more on one side of the body
- Worsen with movement
- Typically starting in the hands, with either one or both hands being affected
- Can involve a “yes-yes” or “no-no” head movement
Timing of tremors
Hand tremors usually occur when hands are used
Tremors are most noticeable when your hands are at your sides or resting on your lap
Doesn't cause other health problems
Characterized by hunched shoulders, sluggish motion, and dragging of the feet when walking
Parts of the body affected
Mainly involves hands, head, and voice
Tremors typically begin in the hands before spreading to the legs, chin, and other areas of the body
- Complete medical history. To rule out the likelihood of enhanced physiologic tremor, a complete list of all medications taken by the patient should be examined. Precipitating, aggravating, or relieving factors such as caffeine, alcohol, medications, exercise, fatigue, or stress should be elicited.
- Detailed neurologic examination. The evaluation relies on a thorough neurologic examination to pinpoint the tremor's precise characteristics, such as its frequency, amplitude, pattern, and distribution, as well as any additional neurologic symptoms that may be present.
- Neuroimaging. There are no specific findings from neuroimaging or other ancillary investigations for confirming the diagnosis of essential tremor, but testing may be necessary to rule out alternative tremor causes.
- Laboratory evaluation. Laboratory tests may include thyroid function, urinary copper, and ceruloplasmin to exclude Wilson disease, and screening for heavy metal poisoning such as lead if any of these causes are suspected.
- Beta-blockers. These drugs are frequently prescribed to treat high blood pressure, but help relieve tremors in some people. Examples of this drug are propranolol, atenolol, and metoprolol. For patients with asthma or certain heart conditions, beta-blockers might not be a choice. The side effects could be fatigue, lightheadedness, or heart problems.
- Anti-seizure medications. These medications may help people with essential tremors who don’t respond to beta blockers. An example of this medication is primidone. Other medications that might be prescribed include gabapentin, topiramate, and pregabalin. Side effects include drowsiness and nausea, which usually disappear within a short time.
- Tranquilizers. Doctors may prescribe benzodiazepine medications, such as clonazepam, to patients whose tremors are made worse by stress or worry. Fatigue or slight sedation are examples of side effects.
- Botulinum neurotoxin (BoNT) injections. Injections of botulinum toxins may be beneficial for some people with severe head or hand tremors.
- Deep-brain stimulation. This is the most common surgical treatment for essential tremors. In deep brain stimulation, an electrode is placed deep within the ventral intermediate nucleus (VIM) of the thalamus to administer electrical stimulation to the brain. Computerized programming of the pulse generator is most commonly done with a handheld device after the patient leaves the hospital to optimize the electrode montage, voltage, pulse frequency, and pulse width.
- Thalamotomy. Stereotactic surgical techniques can create a lesion in the ventral intermediate (VIM) nucleus of the thalamus.
- Focused ultrasound. Approved by the FDA in 2016, magnetic resonance imaging-guided, high-intensity, focused ultrasound thalamotomy is an innovative method for the treatment of essential tremors.
- Avoid caffeine. Dietary stimulants, such as caffeine, increase tremors.
- Drink only in moderation. Although some people find that drinking alcohol marginally lessens their tremors, alcohol is not a good treatment. Once the effects of alcohol wear off, tremors frequently get worse. Also, greater doses of alcohol eventually are needed to ease tremors, which can lead to alcohol use disorder.
- Learn to relax. Stress and anxiety tend to make tremors worse, and being relaxed may improve tremors. Even while there will always be some level of stress in your life, you may alter how you respond to it by employing a variety of relaxation techniques, like massage or meditation.
- Make lifestyle changes. Use your less affected hand more frequently. Look for alternatives to avoid writing with the tremor-affected hand, such as utilizing debit cards and online banking in place of writing checks.
- Your symptoms, including any that seem unrelated to the reason for your consultation
- Important personal information, such as significant stress, recent life changes, and family medical history
- All medications, vitamins, and supplement regimens, including dosages
- Questions to ask your doctor