Tremor: what is it, symptoms, causes, treatment

What is tremor?

Tremor (trembling) - these are involuntary rhythmic oscillatory movements of a part of the body, for example, arms, legs, head, vocal cords, trunk, etc. With tremors, the muscles continually contract and relax.

Tremor types

Tremor may be;

• normal (physiological);
• abnormal (pathological) caused by disorders or medication.

The usual classification of tremors is based on when the tremor occurs:

• Rest tremor: manifests itself mainly in a state of rest.
• Action tremor: occurs during voluntary movements of a certain part of the body. Action tremors include:
  • Intentional: increases when approaching the target (for example, when reaching out to the glass).
  • Kinetic: occurs at the end of the movement towards the target.
  • Postural: occurs when holding a pose (for example, when a limb is extended in one position).

In addition, tremors are classified for reasons that cause them, namely:

• Physiological (a common mild tremor that occurs in all people).
• Essential (common disorder, other symptoms are rare).
• Cerebellar (occurs as a result of damage to a part of the brain called the cerebellum)
• Secondary (manifestation of the underlying disorder or caused by the action of the drug).
• Psychogenic (caused by psychological factors).

Other important characteristics of tremor:

• Jitter frequency: slow to fast.
• Range of motion: fine to coarse.
• Jitter frequency: intermittent or continuous.
• How strong the trembling is.
• How quickly it develops: suddenly or gradually.

- Physiological tremor.

Physiological tremor to one degree or another is present in everyone, including healthy people. For example, most people have a slight tremor with their arms outstretched. This quick and easy tremor results from the constant correction of the position of the hand by nerves that send signals to the muscles. In most people, this type of tremor is almost invisible. However, a normal tremor under certain conditions can become more noticeable and cause concern. Shivering becomes more noticeable, for example, if the person:

• is stressed or anxious;
• refuses alcohol, sedatives (such as benzodiazepines) or opioids;
• consumes caffeine;
• is taking certain drugs, including theophylline and albuterol (used to treat asthma and chronic obstructive pulmonary disease, or COPD), corticosteroids and recreational drugs (such as cocaine or amphetamines);
• suffers from certain medical conditions, such as an overactive thyroid gland (hyperthyroidism) that cause other symptoms /

- Essential tremor.

Essential tremor occurs as a result of a malfunction of the nervous system, but people with such tremors rarely have other symptoms associated with these disorders (neurological symptoms). The cause of this tremor is unclear, but the disorder is often familial.

Essential tremor can start at any age, but it usually occurs in young adulthood. The tremor slowly gets worse and becomes more noticeable with age. Associated with this is another, incorrect name "senile (senile) tremor". Trembling of the arms and legs, and in some cases of the head, is usually observed. If the tremor spreads to the head, it makes involuntary oscillatory movements "yes-yes", "no-no". The tremor usually worsens when the patient holds the limb in weight or makes movements with it.

The essential form of the disorder usually remains mild. Despite this, it can be annoying and embarrassing. It can make it difficult to write and while cooking and eating. For some people, the gradual increase in shaking can lead to disability. Symptoms may resemble Parkinson's disease symptoms. Sometimes doctors really confuse essential tremor with Parkinson's disease. In rare cases, people with Parkinson's disease also have essential tremors.

Rest tremor.

Rest tremor occurs when the muscles are relaxed. The arm or leg trembles, even if the patient is completely relaxed. The trembling becomes less noticeable or disappears completely when moving using the trembling muscles. Rest tremors are often slow and severe.

This tremor develops when nerves are excited in an area of ​​the brain called the basal ganglia. The basal ganglia help initiate and smooth out intentional (voluntary) muscle movements. This type of violation usually occurs as a result of

• Parkinson's disease or diseases with the same symptoms as Parkinson's disease (parkinsonism).

However, resting tremors can also be caused by the use of drugs that affect this part of the brain, for example, antipsychotics and certain drugs to reduce nausea.

The patient may be embarrassed by resting tremors, but since it disappears with movement (for example, when a person drinks from a glass), this type of yeast usually does not interfere with normal activities.

- Intentional tremor.

This tremor occurs when making purposeful movements, for example, when reaching out to an object. Tremors can make it difficult for the patient to pick up the desired item. Intentional tremor increases when approaching an object. This tremor is usually relatively slow and severe.

The intentional form of the disorder develops with damage to the cerebellum (the part of the brain responsible for balance and coordination of movements). Thus, cerebellar and intentional tremor can be used synonymously.

Common causes of intentional tremor include:

• some hereditary diseases affecting the cerebellum (spinocerebellar ataxia);
• multiple sclerosis.

Other disorders that can also cause dysfunction of the cerebellum, resulting in intentional tremors. They include:

• stroke;
• tumor;
• alcoholism;
• abuse of sedatives or anticonvulsants.

Do you know that…

All people have tremors to one degree or another. If it is weak, it is enough to use simple techniques to facilitate movements, for example, keeping objects closer to you

- Postural tremor.

This tremor becomes more noticeable when the patient holds the limb in a certain position, for example, when he stretches his arms in front of him.

The most common postural tremor is

• essential;
• physiological (normal).

- Complex tremor.

A complex tremor is one that has characteristics of more than one type of normal tremor.

Common causes of complex tremors are

• psychological factors.
• common nerve damage, such as diabetes mellitus or Guillain-Barré syndrome.

Causes and risk factors

Tremor develops in many diseases.

Most often, the condition occurs as a result of the following:

• physiological tremor (the most common, everyone has);
• disorders of the nervous system;
• Parkinson's disease;
• multiple sclerosis as a result of damage to areas of the brain that control movement.
• liver disease;
• due to alcohol withdrawal;
• overactive thyroid gland (hyperthyroidism)
• due to hereditary disorders affecting the cerebellum; it can be, for example, Friedreich's ataxia and spinocerebellar ataxias
• use of certain drugs or exposure to certain toxic substances
• psychogenic tremor (caused by psychological factors)

Sometimes there is more than one cause of the tremor.

Signs and symptoms

The information below will help you decide when to see a doctor and what will happen during the examination.

The following symptoms are cause for concern:

• A tremor that started suddenly
• Tremors in people younger than 50 years old who do not have relatives who have had essential tremors
• Tremors are accompanied by other neurological symptoms such as changes in mental status, muscle weakness, changes in gait, and difficulty speaking.
• Arousal and heart palpitations.

- When to see a doctor?

If warning signs appear, you should immediately consult a doctor.

If there are no warning signs, you should see your doctor as soon as possible.

When examining a person under the age of 50, whose relatives did not suffer from essential tremors, the doctor be sure to find out if the symptom is caused by another disease, drug, or drug.

Diagnostics

Doctors first ask about symptoms and take a history, and then do a physical examination. The data obtained by doctors from the history and physical examination often indicates the cause of the disorder and the investigations that may be required.

Doctors ask the following questions about tremors:

• Did it start suddenly or gradually?
• What parts of the body are affected?
• What triggers the tremor (for example, movement, resting, or standing)?
• What weakens and increases tremors (alcohol, caffeine, stress, or anxiety)?

Do you know that…

For some types of tremors, drinking a little alcohol helps, but chronic alcoholism can damage the brain, leading to tremors.

If the condition starts suddenly, the doctor will try to find out what may have triggered it (such as a recent injury or a new drug).

To identify disorders associated with tremor, the doctor examines the patient's history. The doctor asks if any close relatives have had tremors. The doctor checks what medications the patient is taking, and finds out if the patient drinks coffee, alcohol and other drugs (including whether he has stopped taking them).

During the physical examination, the doctor performs a neurological examination (including paying attention to the patient's gait). The doctor notes which part of the body is trembling, and in which situations the frequency of the tremor is higher:

• Part of the body is at rest and rests on something completely (for example, hands on the knees while sitting).

• Maintaining a specific posture (for example, arms extended forward).
• Walking or performing activities with a trembling body part.

To find out if the patient's voice has changed, the doctor may ask the patient to make a long sound.

Usually, a doctor can determine the type of disorder based on the features, history, and results of a physical examination. For example

• Tremors that develop gradually: usually physiological or essential.
• Postural tremor that starts suddenly: Possible psychological factors, poisoning, illness (such as hyperthyroidism), alcohol withdrawal, or stopping the drug (this could be a sedative of some kind) or treatment with a drug known to cause shiver.

- Carrying out analyzes.

Brain imaging magnetic resonance imaging (MRI) or computed tomography (CT) is performed in the following cases:

• The person has other neurological symptoms that indicate a brain disorder, such as stroke, tumor, and multiple sclerosis.
• The tremors started suddenly or progresses rapidly.

Blood tests can be conducted to identify possible causes when the cause is unclear. Surveys may include:

• Determination of blood sugar levels.
• Tests to assess how the thyroid, parathyroid, liver and kidneys are working.

In rare cases, electromyography (recording the electrical activity of the muscles when they are stimulated). However, it can be done when nerve damage is suspected as a cause.

Standard treatments

The doctor treats the underlying cause, if possible, such as stopping a medicine that is causing the tremors or treating hyperthyroidism. Parkinson's disease is treated with levodopa or other drugs.

At weak tremor no treatment is required. If the tremors are severe and bothersome, there are some simple things you can do:

• in order not to drop the object, hold it firmly and close to the body;
• avoid uncomfortable postures;
• Avoid other conditions that cause tremors (such as caffeine intake, lack of sleep, or fatigue).
• use assistive devices as advised by a specialist in recovery and maintenance of impaired skills.

Assistive devices may include swinging knives, large handled cooking utensils; If the tremor is severe, you may be advised to use hooks to fasten buttons, Velcro instead of buttons and laces, zippers, straws, shoe horns.

- Physiological tremor.

Tremors can be reduced by avoiding or minimizing triggers. For example, don't drink coffee, get enough sleep, and avoid stress.

If it becomes difficult to do routine activities (such as using dishes and drinking from a glass), or if shivering disturbs the person at work, the doctor may prescribe medication.

People with physiological tremors and anxiety may benefit from a small dose of benzodiazepines (sedatives) such as lorazepam. However, these drugs should only be used sporadically.

If physiologic tremors are aggravated by the need for prescribed medications or severe anxiety, propranolol beta-blocker may help.)

- Essential tremor.

Some people are helped by moderate drinking, but doctors do not recommend this method as a treatment. Sudden withdrawal from alcohol after drinking in significant quantities increases the tremor.

Anticonvulsants (primidone, topiramate, or gabapentin) or propranolol may also be used if tremors are to be controlled.

If other drugs have failed to treat essential tremor, benzodiazepines may be used.

- Intentional tremor.

Intentional tremors are difficult to treat, but the tremor can disappear when the underlying disease that caused it is healed.

If the cause of the tremor cannot be corrected, your doctor may advise wearing weights on the wrist or ankle of the affected limb to reduce yeast. In addition, the patient can be taught to hold a limb when performing any action. Sometimes these measures help.

- Deep brain stimulation.

During this procedure, tiny electrodes are inserted into the area of ​​the brain responsible for the occurrence of tremor - the basal ganglia (an accumulation of nerve cells that help smooth out muscle movements). The electrodes send small electrical impulses to the shivering specific areas of the basal ganglia to help relieve symptoms.

Deep brain stimulation is sometimes used for severe, disabling tremors that cannot be treated with medication. Such treatment is sometimes required for essential tremors and tremors in Parkinson's disease and some other diseases. Such treatments are used only after attempts at drug therapy have been found to be ineffective. These treatments are only available at specialized centers.

The main things older people need to know are:

Many older people do not see a doctor because they believe tremors are part of the normal aging process. This is the wrong approach. You need to see a doctor: the doctor will conduct a physical examination, talk to the patient and find out the possible causes of the tremor. The doctor can then give helpful advice on how to live with the tremor, and possibly prescribe medications to relieve it.

In addition, older people take a lot of medications and are more susceptible to their side effects. Some medications can cause tremors in the limbs. When prescribing such a medicine to an elderly person, the doctor tries to choose the lowest effective dose. This dose may be lower than those used to treat younger patients. In older people, doctors avoid the use of drugs with anticholinergic effects whenever possible.

Tremors can markedly reduce the quality of life of older people and their ability to perform various activities. This is especially important if the tremor is accompanied by physical or mental disorders. Physical therapists and occupational therapists can offer older patients simple ways to manage tremors and assistive devices that improve their quality of life.