Tremor is the uncontrollable shaking of a body part. Nearly everyone experiences tremor at some point, most often as a result of fear or excitement. However, persistent uncontrollable shaking is a common symptom of neurological disorders that destroy nerve tissue, such as Parkinson’s disease or multiple sclerosis. Tremor may also occur after stroke or head injury. Other tremors appear without any underlying illness. For example, essential tremor (ET) is caused by abnormalities in areas of the brain that control movement. ET alone affects approximately 5 million people in the United States.
Tremor is the most common of all involuntary movements. Although tremor can affect various body parts including the hands, head, facial structures, vocal cords, trunk, and legs, it most frequently occurs in the hands.
Symptoms of tremor may vary from patient to patient, but typically include shaking and trembling, occurring most frequently in the hands.
Keep in mind however that tremor itself is a symptom of numerous potential underlying neurological disorders and conditions including Parkinson’s disease, multiple sclerosis, Dementia with Lewy Bodies, Dystonia and Friedreich’s ataxia to name a few.
Diagnosis depends largely upon where and how the tremor appears. This means that your doctor will look for an underlying source for the tremor using a variety of diagnostic techniques. A computed tomography scan (CT scan) or magnetic resonance imaging (MRI) may help to diagnose multiple sclerosis or other disorders of the central nervous system. Blood tests may be used to rule out metabolic causes, such as thyroid disease.
Essential tremor, which is usually hereditary, is common in older people. Since an underlying disease does not cause ET, a comprehensive family history is particularly valuable in the diagnosis of inherited tremor.
The treatment of tremor depends largely on its severity and underlying cause.
Some successful pharmacological treatments include:
- Beta-blockers such as atenolol (Tenormin) and propranolol (Inderal).
- Antiseizure drugs such as primidone (Myidone, Mysoline),
- Benzodiazepines: Clonazepam
- Antiparkinson drugs such as Levodopa.
Many people find that drinking small amounts of alcohol temporarily relieves tremor. This is a useful fact for making the diagnosis, but alcohol is not a desirable treatment – you should avoid heavy drinking. Also avoid caffeine (in substances such as coffee and soda) and other stimulants because they tend to exacerbate tremor symptoms.
Botulinum toxin (Botox®) injections have proven to be effective in treating head, hand, and voice tremors. Equally promising, deep brain stimulation is a relatively new technique for controlling severe tremor. The patient activates a surgically implanted generator using a hand-held magnet. The magnet delivers an electronic pulse to the brain that blocks the signals which trigger tremor.
Other surgical procedures for patients with severe tremor include:
- Thalamotomy: the surgeon destroys part of the thalamus, the part of the brain that coordinates nerve impulses relating to the senses of sight, hearing, touch, and taste.
- Pallidotomy: the surgeon destroys part of a small structure within the brain called the globus pallidus internus, that part of the brain that helps control movement.
- Deep Brain Stimulation: This is now the preferred surgical intervention.
- Stem cell transplant: the surgeon implants fetal tissue in a patient’s brain to replace damaged nerves.
Because both thalamotomy and pallidotomy destroy portions of the brain that affect senses and movement, these procedures may have a permanent negative impact on balance and coordination. Stem cell transplant remains a highly controversial treatment.
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