Tremors

Tremor is a rhythmic, involuntary muscular contraction characterized by oscillations of a part of the body or the whole body.

Causes of Tremors

Physiologic Tremors

Normal tremors can be detected with sensitive devices and are generally not clinically visible unless there are exacerbating factors.

The most common type of tremors for which people will seek medical advice are essential tremors. They are often benign, hereditary, usually occur in the fourth decade and generally tend to increase with age, although it can remain stable for long periods of time. Typically essential tremors are isolated to hands and fingers, may be absent at rest, and can be induced by sustained posture such as writing and using utensils. This often involves the head, voice and rarely the legs. These tremors may worsen with stress or alcohol.

Task-specific

They occur only with specific activity such as writing or holding things in a certain position. This may be a variant of essential tremor.
The treatment of essential tremors depends on the severity of the impairment. If the symptoms are mild, no treatment is required. If, however, the symptoms are severe, various drugs may be helpful in controlling the symptoms in over half the patients. Treatment options include beta-blockers, benzodiazepines, even neurosurgical intervention may be necessary depending on the severity of symptoms.

Parkinsonian

They are characterized by a symptom complex including rigidity, slow movements, and postural instability. Most have and present with a tremor. Typically this occurs in older patients who are over 60 years old. Usually it is worse at rest and absent during sleep. There are movements of the hands and fingers that resemble the act of rolling a pill between the fingers. The tremor generally decreases with relaxation and with goal-directed movements. The treatment is anti-Parkinsonian drugs and surgery for certain types of Parkinsonian tremors. In Parkinsonism secondary to neuroleptic drugs, the tremors are not very prominent. Wilson’s disease, disease of abnormal copper metabolism, may also manifest with a Parkinsonian tremor.

Cerebellar

This type of tremor is most prominent during sustained posture. The rhythm is coarse and generally side-to-side movement during intentional activity. It is not evident at sleep or during relaxation. Usually there is an underlying disease process, and the goal is to treat the underlying problem. If the symptoms are evident on just one side of the body, one need to consider tumor. If the symptoms are evident on both sides of the body, it may be due to cerebellar degeneration, multiple sclerosis, Wilson’s disease, or toxins.

Miscellaneous

Causes include alcohol abuse and alcohol withdrawal. Certain medical conditions such as hyperthyroidism may manifest with fine tremors.

Psychogenic

These are fine tremors resembling the shaking of someone who may be fearful. These may be related to anxiety.

If the tremors are really vigorous with shaking and jerking of some parts of the body, one needs to consider epileptic seizures. In people with epilepsy, brain cells create abnormal electricity that causes seizures. A seizure may cause “jerking” movements. In some cases, seizures cause only a loss of consciousness, a period of confusion, a staring spell or muscle spasms. Treatment of epilepsy involves prolonged treatment with anti-epileptic drugs.