Tremor or hand shaking – is it normal? Causes and when to see a doctor

What is tremor?

Tremor is when you cannot control involuntary rhythmic twitching or shaking in any part of the body. Shaking can occur normally. But if tremor affects your life, you should see a doctor to find the cause of this condition and for treatment.

Tremor is the most common manifestation of movement disorders. It is often called tremor. Most likely borrowed from Latin – tremorem, meaning “involuntary shaking”

Tremor can occur in different muscles, affecting one area of the body or several at once. There are tremors of the hands, legs, torso, head, lips, chin, voice, muscles of the pharynx, larynx, and face.

When is tremor considered normal?

Can healthy people experience tremor?

It’s normal to have a slight tremor. A minor and almost imperceptible tremor is present in all people. This tremor is called physiological.

When a normal person extends their arms in front of them, they will not be completely still.

Tremor may become more noticeable

• with age
• when you experience stress, fatigue, anxiety, or anger
• with excessive physical exertion
• after consuming caffeine
• related to smoking
• if you are very hot or cold

Some medications and illnesses can also cause tremor. Talk to your healthcare provider before stopping any prescribed medications.

Why do hands tremble during anxiety?

During a stressful situation, stress hormones and the nervous system response accelerate our heart rate, blood pressure, and breathing. Simultaneously, muscles prepare for action, leading to sensations of trembling, twitching, or shaking muscles.

What are the causes of tremor or why does tremor occur?

Attention! Tremor occurs in different conditions of the body and various causes are treated differently. Therefore, it is very important to be examined by a specialist. Do not wait for the disease to progress. If treatment is necessary, it is better to start it on time. And if there is nothing serious, it is better to know this earlier and live happily and without worry.

Physiological

Tremor can occur in healthy people. If a doctor has examined you and found no diseases, it can be said that this trembling is physiological and a variant of normal. The causes of such tremor are simply related to the characteristics of a normal body.

Physiological tremor is an action tremor present in every healthy person. It becomes more pronounced during periods of muscle fatigue, anxiety, emotional stress, fear, or excitement. These tremors are mostly reversible if the provoking factor is identified and eliminated. The frequency of physiological tremor in young people ranges from 8 to 12 Hz, gradually decreasing with age to about 6–7 Hz in individuals over 60

Neurological diseases

Pathological tremor can be a symptom of a neurological disease from the group of movement disorders:

Tremor is usually caused in areas of the brain that control movements. Since shaking is most often observed in older age groups, scientists associate its development with impaired impulse transmission processes in brain cells due to certain age-related changes.

There are also genetic causes of tremor development in certain diseases, where changes in genes lead to impaired brain function.

Pathological tremor can be a symptom of a neurological disease from the group of movement disorders:

Essential tremor

Essential tremor – neurological   slowly progressing disease,   the main symptom of which   is tremor   during movements (action tremor). More often in shaking   hands and head are involved

Essential tremor is a benign condition, often inherited. Patients with essential tremor note that they have observed shaking of the hands, chin, and head in their close relatives. Most often, the tremor is symmetrical and appears during movement.

More scientists are inclined to believe that the main component of the disease and the likely starting point is degenerative/destructive changes specifically in the cerebellar cortex, with a decrease in the number or an increase in the deformation of cells called Purkinje cells in patients with essential tremor.

Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder caused by  progressive destruction and death of neurons producing the neurotransmitter dopamine .

In patients with Parkinson’s disease, the cause of tremor is believed to be an imbalance at the level of the basal ganglia against the background of low dopamine production , in the case of dystonias, several areas of the brain are involved, and the disease is considered a network disorder, which also includes the cerebellum, thalamus, and cortex

For Parkinson’s disease cshe one of the characteristic signs is the presence of tremor—more often in the hands and often asymmetrical (more on the left or right). It is important to distinguish different types of hand tremors based on two main criteria:

• which one? (amplitude and frequency)
• when? (during certain actions or at rest) does tremor occur

More characteristic of Parkinson’s disease is undoubtedly resting tremor. It occurs in a part of the body that is completely relaxed (or at rest). For example, the hand rests calmly on the knees, hangs along the body while sitting or walking—in all cases, this tremor resembles counting coins or rolling pills.

Lifehack for patients with pronounced resting tremor: you can stop this shaking with the simplest actions — just by moving your hand, patting your thigh, handling beads, or twisting a handkerchief in your hands

Disease onset most often occurs after the age of 50.

Tremor in this case is asymmetrical. For example, only one hand starts to shake at first. Tremor in Parkinson’s disease is more pronounced at rest or when maintaining a certain position, rather than in motion.

Apart from tremor, in Parkinson’s disease, the patient may have a number of other complaints:

• stiffness in the body
• gait change
• slowness of movement
• Depression
• sleep disorder
• pain in the limbs
• olfactory disorder

Dystonias

More about dystonia here

Stroke

Stroke is brain damage due to disrupted blood supply (ischemic) or hemorrhage (hemorrhagic). After a stroke, the so-called Holmes tremor may occur. Our center has experience in successfully treating Holmes tremor with focused ultrasound.

Multiple sclerosis

In multiple sclerosis, the mechanism of disease development is related to the immune system attacking its own brain. Multiple sclerosis has specific treatments that can stop the progression of the disease. Therefore, it is extremely important to detect the disease in time, especially because it sometimes has atypical forms and masquerades as tremor.

Wilson-Konovalov disease

Wilson-Konovalov disease is a hereditary disorder associated with copper metabolism disruption. We regularly identify this disease when patients come to us with tremor; it is very important to rule it out because the treatment for this disease is different.

Tremor in Other Diseases

Tremor can sometimes be caused not directly by neurological diseases or conditions but as a result of changes in the nervous system’s function due to other diseases related to systemic metabolic or hormonal (endocrine) causes. We identify such pathological conditions through specific biochemical abnormalities in blood or cerebrospinal fluid analysis. Identifying these conditions is crucial because many of them have effective targeted treatments that can alleviate tremor. It is important to pay attention to treatable causes, as delays in diagnosis can adversely affect prognosis and outcomes

Taking certain medications

Tremor can be caused by certain medications. For example, asthma medications, corticosteroids, drugs used in oncology, psychiatry, and neurology.

Heavy Metals and Other Neurotoxins

Exposure to heavy metals such as mercury, manganese, lead, arsenic, organic solvents, drugs, alcohol, or pesticides can cause tremor.

Endocrine diseases

• Thyrotoxicosis. In thyrotoxicosis, which is most often caused by diffuse toxic goiter, there is an increase in thyroid hormones, leading to the enhanced functioning of all organs and systems of the body, including muscles, resulting in trembling of the hands and eyelids.
• Pheochromocytoma

Liver or kidney failure

Liver and kidney failure with the accumulation of toxins in the blood can cause damage to certain areas of the brain, leading to tremor or convulsive movements. For liver diseases, the characteristic is “liver flap tremor” or “flapping tremor”.

Diabetes mellitus

High or low blood sugar levels (hyperglycemia or hypoglycemia) can cause tremor or other involuntary movements .

Unlike patients with movement disorders, such tremors usually subside when the cause is addressed, which is another reason to visit a doctor, identify the cause, and return to normal life.

Vitamin Deficiency

Tremor is one of the symptoms of thiamine (B1) deficiency

Tremor when you quit smoking

This type of tremor appears if the usual amount of nicotine does not enter the body. This disrupts the metabolism of neurotransmitters such as   for example, dopamine, which can lead to changes in muscle tone and the appearance of tremor

Don’t worry and continue on your path to quitting smoking, the tremor will soon pass, and your body will thank you

Treatment Without Incisions Using MRI-Guided Focused Ultrasound

The innovative treatment method that fulfills patients’ dreams of healing from tremor without incisions, anesthesia, or hospitalization is MRI-guided focused ultrasound. This method was approved by the FDA for the treatment of patients with essential tremor in 2016, and by Roszdravnadzor in 2017.

Tremor is not a sentence. Much depends on your attitude towards it, the presence of limitations in daily life, social and professional life, as well as the team of doctors who guide and assist you in this life challenge.

Consult the professionals and they will do everything to restore your ability to drink tea, brush your teeth, button up, shave, and type messages to loved ones on your phone screen.

What kind of tremor do I have?

Let’s take a detailed look at the different types of tremor

Resting tremor

If  tremor occurs when the hands or feet are   at rest and do not perform  no movement, then it is resting tremor. This type of shaking is most characteristic of Parkinson’s disease. The hands or feet are most involved in the tremor.

Action tremor

If the shaking intensifies and occurs during actions, it is action tremor. Neurologists sometimes call it kinetic, from the word action, action. At rest, without performing movements, there is no tremor. When shaking occurs only during a specific action, such as writing, it is action tremor. If the action is not performed, the tremor does not appear.

Postural tremor

If the shaking occurs when trying to maintain a certain posture, it is postural tremor. The name is derived from the word posture – posture. Tremor can be detected when performing movements against the force of gravity: for example, holding arms extended forward.

Kinetic tremor

Trembling during any action is called kinetic tremor. The name is derived from the word kinetic – mobile/dynamic

Kinetic tremor occurs during any voluntary movement. It can be an intentional tremor, task-specific tremor, or simple kinetic tremor. Kinetic tremor that intensifies at the end of a visually guided purposeful movement is called intentional tremor.  Task-specific tremor occurs during the performance of highly skilled activities such as writing, shaving, or playing a musical instrument.

Intention tremor

Kinetic tremor, which intensifies at the end of a controlled purposeful movement when approaching the target, is called intention tremor. The name is borrowed from the word intention – intention or goal

Task-specific tremor occurs during the performance of highly specialized  actions such as writing, shaving, or playing a musical instrument

Isometric tremor

Isometric tremor occurs when muscles tense against a stationary object. For example, this can be tested by clenching a fist or the fingers of another person.

Orthostatic tremor – tremor of the leg muscles when standing. It may manifest as instability while standing. The tremor disappears when a person starts walking or sits down. People with this type of tremor usually stand with their legs wide apart for stability but walk without problems.

Your doctor will help you determine the cause of the illness, suggest examinations and treatment.

When to see a doctor for tremor?

1. Consult a doctor if the tremor worsens over time
2. Tremor prevents you from living fully, limiting daily activities

Your doctor will help ensure that the tremor is not caused by another condition. They can also suggest treatment.

What to expect at a doctor’s appointment for tremor?

To determine what might be causing your tremor, the doctor will examine you and find out:

• Do you have any other symptoms
• Do you take any medications
• Your story
• Family Diseases — some types of tremor are hereditary
• The doctor will conduct special tests for tremor

Mild tremor not caused by another condition usually does not require treatment. The doctor may simply monitor you to ensure the condition does not worsen.

If the doctor suspects that the tremor is not normal, additional tests may be required, which are generally painless and do not cause discomfort

You may be referred to a specialist for additional tests if your tremor could be a symptom of a condition such as essential tremor, Parkinson’s disease, or multiple sclerosis.

How do neurologists assess tremor?

To assess the condition of patients, doctors conduct a neurological examination with numerous tests that enhance tremor and also use various scales.

Scales are necessary to dynamically assess your condition and to understand the severity of changes. The most commonly used scale for assessing tremor is the Clinical Rating Scale for Tremor – CRST; both a general assessment and a separate assessment for each side of the body are conducted.

One of the oldest and very effective methods for diagnosing tremor is drawing Archimedean spirals. You can even perform this test yourself. Print the drawing for the right and left hand. There are several techniques: keeping the hand in the air without touching the table, or placing the hand on the table as during regular writing. You need to trace all the lines drawn as an example. Drawing the spirals should be from the center to the periphery. You connect the point in the center of the spiral with the one on the periphery, guiding your hand inside the drawn spiral, trying not to cross the lines.

What diagnostic methods for tremor help a neurologist?

In cases of tremor of any localization, a neurologist’s examination is the primary tool for making an accurate diagnosis. In neurology, there is a separate specialty for a neurologist specializing in movement disorders, who focuses deeply on this issue.

A specialist in movement disorders, depending on the clinical picture, location of the tremor, duration of the disease, your age, and family history, will work with you to develop a diagnostic and management plan.

Various instrumental diagnostic methods are used to assess tremor.

Very often, patients noticing tremors in a part of their body independently opt for an MRI of the brain or an MRI of the cervical spine for head tremors, but not all movement disorders have any manifestations during routine  magnetic resonance imaging of the brain. In some cases, such as suspected Parkinson’s disease, a special study is required that includes the determination of nigrosome-1 (https://pmc.ncbi.nlm.nih.gov/articles/PMC6732928/). Our MRI diagnostic specialists have been conducting brain studies to determine neurodegenerative diseases for many years.

In patients of the young age group, metabolic diseases such as Wilson-Konovalov disease are always ruled out by determining ceruloplasmin in the blood, copper content in daily urine, and an ophthalmologist’s examination for the detection of Kayser-Fleischer rings in the corneal membrane of the eye.

To determine the amplitude and frequency of muscle contractions in tremor   used  electroneuromyography , This research identifies the muscles involved in tremor and   the frequency of their contractions in hertz

Tremor Treatment

If the doctor, after examination, considers the tremor to be abnormal, the treatment will strictly depend on the causes of the shaking. For example, if it is a neurological disorder, you will most likely be treated by a neurologist or even a neurosurgeon. If it is another condition, the appropriate specialist will be able to prescribe the correct treatment!

Lifestyle

Any treatment begins with a healthy lifestyle, proper nutrition, physical activity, and exercise.

There are various life hacks on how to overcome tremor.

Avoiding excessive consumption of caffeine and alcohol can help reduce tremor.  Such relaxation methods as  massage and meditation can also alleviate the condition. You can modify the approach to tasks: for example, instead of handwriting, use typing on a computer

Medications

If you have a tremor that affects your life, your doctor may prescribe medication. Medications do not always cure tremor, as it depends on the cause, but they often help reduce the shaking.

You may need to take medication continuously or only when necessary — for example, before a stressful situation that worsens the tremor.

Medication is often taken for a long period.   Medications used for the treatment of tremor belong   to different groups of medications and are prescribed by a doctor considering indications and contraindications  

If tremor affects your head or voice, you may be offered injections to block nerves and relax muscles (botulinum therapy).

Surgical Methods

In some cases, brain surgery may be an option for treating severe tremor that does not respond to medication. Such surgeries may include:

• Radiofrequency ablation
• Deep brain stimulation

MRI-guideded focused ultrasound

MRI-guideded focused ultrasound treatment is a non-invasive procedure that does not require anesthesia, where ultrasound waves from a special helmet are directed and focused on the area of the brain causing the tremor, disabling it. This ensures rapid patient recovery. The procedure is performed by a neurosurgical team. The treatment is OFFICIALLY approved for both tremor and Parkinson’s disease and is NOT experimental.

How to Reduce Tremor in Life #LifeHacks

Many patients with tremor use various strategies to reduce its impact in daily and social life. There are many ways to make it less noticeable. When communicating with them, we always asked how they do it and gathered the most common tips.

The most important advice is to maintain a positive mood and try to minimize reactions to stressful situations. Stress with the release of a large amount of hormones leads to increased tremor. If you can’t hold back, try to occupy yourself with something else through willpower to distract your brain. It is very lazy and cannot perform multiple tasks at once—sing, recite a poem, wiggle your toes (if there are other people around), breathe deeply. As soon as the brain is distracted by something else, the tremor will automatically decrease.

It’s better to inform those around you in advance that you have a special condition with tremor. This way, there won’t be a stressful situation for you, and others will try to help.

Learn to maximize the use of your hand without trembling for as many activities as possible, including writing. You can always retrain. Moreover, it develops the brain and slows down its aging process. Perform all actions slowly, trying to concentrate and feel the movement.

When hands tremble  movements need to be performed   not in the air, use support

• keep your elbows close to your torso and press them against your body
• rely   elbows on  surface when performing actions
• hold and stabilize   hand with tremor using the other, non-shaking hand  

Use the hand without tremor to stabilize the one with tremor. You can support the trembling hand. Once the hand has support, the tremor decreases. To do this, keep your elbows close to your body or rest them on a surface when performing actions. While reading books, newspapers, and magazines, try not to hold them in the air.  

The most common advice is to wear wrist weights. They are not very bulky, almost unnoticeable under clothing, and are sold in sports stores. The selection should be individual and depends on the strength of your muscles. How to choose the right weight – try different options by mass and try to perform certain movements, like drinking water or signing your name. If you notice a significant improvement, then that is the weight you need. You can wear them on both hands or the one that shakes more.

Eating and drinking are the most painful moments in life for patients with tremor, especially in the presence of strangers. The following simple steps should help you:

• Use cups with lids and straws for drinks and soups. Always keep a couple of straws with you in case they are not available at a café or with friends.
• Try to acquire heavier dishes, such as mugs, plates, spoons, and forks. Holding heavier items reduces tremor.   Use both hands to hold objects.
• Use bowls with high sides for soup, as it’s harder to spill from them. It’s better to use spoons like those in Chinese or Japanese restaurants for soup. They have high sides, reducing the risk of spilling.
• Try not to fill soup, tea, or coffee to the brim. It’s harder to spill if there is less liquid in the container.
• To reduce the sound of utensils hitting the edges of plates, glasses, and cups, special rubber rings can be used.
• To reduce the movement of plates and cups on the table, you can use special rubber mats on the table.
• Currently, there are many spoons specifically designed for people with tremor. They are heavy and equipped with a device to maintain a steady position despite shaking.
• When pouring from one container to another, it’s better to do it with everything placed in the sink.
• While preparing and eating food, wear aprons and protective scarves to avoid staining your clothes. You can take several scarves with you to a restaurant or cafe, which can be changed as stains appear.

Restaurant and café visits or visiting friends become a real challenge. Many patients try to avoid them. Below are tips that help endure these events:

• Ask the waitstaff to serve dishes already cut into small pieces.
• Ask for the soup to be poured into a large mug for you. You can add pieces of bread to the soup. It will no longer be a liquid that is easy to spill. At this point, you can say that your grandmother taught you to eat this way since childhood.
• Ask to fill the glass with drinks halfway.
• Mashed potatoes or other types of puree are often on the menu; they are easier to pick up with a fork.
• Bring along several scarves that you can change discreetly in the restroom as stains appear.

If you are in a large company, you can always approach the waiter at your table and speak privately, pointing out your preferences and asking not to draw attention to your requests.

Beauty and Care – these are also important aspects of life where hand tremors greatly interfere

• Create a hairstyle that requires minimal effort
• To ensure the eyeliner is even, it’s better to apply makeup while sitting, with your elbows resting on a table
• An electric toothbrush and razor are easier to use with tremor.

Clothing and accessories . For people without tremor, it is hard to imagine that even buttoning a shirt can be difficult. Tips for reducing shaking:

• Clothing should be light and comfortable, not restricting movement.
• The presence of a hood on jackets, coats, and down jackets frees up your hands in case of rain and the need to carry an umbrella.
• It’s better to use small bags with a simple magnetic clasp over the shoulder to free up your hands.
• If there is resting tremor, especially on one side, and a desire to hide it, you can weigh down a bag by placing a dumbbell weighing 2-3 kg and carry it in that hand.

A very important concern is the ability to write and sign. What to do to make life easier:

• Try to type everything on the computer rather than writing
• It has been observed that writing in lowercase is easier than in uppercase.
• Place your palm and elbow on the table, bring the elbow closer to yourself for greater stabilization, and additionally support it with the hand that has no or less tremor.  
• Holding a pen or pencil between the index and middle fingers makes writing easier.
• A sheet of paper on which you write is better placed on a magazine or notebook to control the tremor and not tear the paper.
• Use a pen or pencil with a thick rubberized grip, choose heavier options or you can add weight to the object.
• Now all phones and messengers allow you to record messages instead of typing them.
• For painting, use special stamps. They are easy to make and can be notarized.
• Get business cards with your name and address; if asked to write down your information, you can either stick them on or ask them to copy from them.
• Try to fill out all official documents, applications, and forms at home in a calm environment. You can always claim that a particular document is missing and request a blank form to fill out.

Use of Mobile Phones also becomes difficult, especially with the advent of devices where the buttons are only touch-sensitive

• To stay connected, it’s better to have a button phone with large buttons. They are hard to find now, but various vintage electronics stores can help.
• During the conversation, use headphones. There are large ones that cover the entire ear. The in-ear headphones can be difficult to insert on the first try with hand tremors.
• If you still use a modern phone, rely on voice assistants to dial the phone number.

Life of a modern person is hard to imagine without the help of a computer. What life hacks can be used:

• Ask to set up the computer to allow double keystrokes and repeated characters on the keyboard, as well as double clicks.
• While working, try to place your hands on the table in front of the keyboard.
• Choose the mouse that suits you best.
• Check the speech recognition software. It is already installed on some computers.

With tremor, the proper organization of home space can significantly ease your life:

Safe Kitchen for Tremor

Cooking is often a labor-intensive process. You may experience difficulties operating many kitchen appliances. Due to balance disorders, opening the refrigerator, oven, and kitchen shelves can be challenging.

1. Install convenient and durable handles for cabinets.
2. Store necessary items in drawers that are easily accessible for quick use.
3. Use a single-handle faucet for the sink.
4. If you haven’t had a dishwasher, now is the time to get one. Holding wet dishes can be difficult even without tremor.
5. When experiencing tremors, it is difficult to carry and hold dishes, so it is better to move all necessary utensils to table level.

Bathroom Safety if You Have Tremor

The risk of being in the bathroom and restroom is high. Most falls occur due to difficulties when getting up from the toilet, entering and exiting the bathtub. You may experience difficulties due to poor lighting in the bathroom, and it may be challenging to stand on a wet surface.

1. Install grab bars near the toilet, bathtub, and shower. Do not use towel racks, faucets, or soap dishes for support when standing up.
2. For safety, add a sturdy bench with a backrest to the bath or shower.
3. Provide a seating area for brushing teeth and shaving.
4. Do not walk when the bathroom floors are wet. Do not store anything unnecessary in the bathroom.  
5. Place a non-slip mat at the bottom of the bathtub, shower cabin, or nearby.

Toilet Safety

• It’s better to lay a special non-slip mat on the floor nearby

A Comfortable Bedroom if You Have Tremor

1. Adjust the bed height so that, when sitting on it, your feet confidently touch the floor.
2. Install side rails or a special support to facilitate the process of turning and getting out of bed.
3. Ensure convenient access to light sources to eliminate the need to move in the dark.
4. Use a bright nightlight or flashlight for good visibility on the way to the bathroom.
5. Keep a flashlight near the bed in case of a power outage.
6. Place the clothing hangers at a convenient height, ensure the wardrobe is well-lit, and that items inside are easily accessible without extra effort.
7. Keep frequently used items, such as your phone or watch, on the bedside table so you can reach them without getting up.
8. Avoid using slippery materials for bedding and nightwear.

Garden Care for Patients with Tremor

• Since taking care of plants can become a complex process, it’s better to switch to potted plants, as both flowers and vegetables grow well in pots, the main thing is to choose the right size. You always have helpers who can lift the pot for you to weed or water. Moreover, potted plants can be moved around the garden every week, adding novelty

Checklist for Organizing Space in Your Home

1. Remove all household items that could cause falls, such as rugs.
2. Ensure that the floors are level, stable, free of cracks and gaps, and their surface is not slippery.
3. Ensure that all furniture is securely fixed, without sharp edges, sturdy, and immobile. Chairs should be stable, with armrests, without a swivel base, and with sufficient seat height for easy rising.
4. Ensure quality lighting in all rooms, adjust curtains and blinds to avoid glare.
5. Organize spacious areas for movement in the corridors. If necessary, equip them with walkers or wheelchairs.
6. Remove electrical wires from movement areas to eliminate the risk of tripping and falling.

Driving a car if your hands are shaking

• If you have a manual transmission, it would be better to switch to an automatic one, where there is no need to constantly shift gears

Tips for Patients with Parkinson’s Disease

What difficulties do people with Parkinson’s disease most often face? One of the main problems is instability while walking (stumbling, episodes of “freezing”) and difficulty maintaining balance in certain positions. These issues often lead to falls and serious injuries. To reduce the risk of such situations and make the environment safer, it is important to adapt the living space.

• try to engage the trembling hand in some motor task that blocks the pathological signals causing resting tremor. This could be squeezing a ball or rolling coins between your fingers. There are special anti-stress toys.

Tips for Patients with Head Tremor

• Hold your chin with your hand or press it to your chest, or turn your head to the side to reduce involuntary movements.
• During a conversation, tilt your head to the side rather than keeping it straight ahead. Also, slightly turn your torso and head towards the other person. This looks quite natural, like a regular movement, but significantly reduces head tremor.

The most important advice is not to hesitate to ask for help! Sometimes we think that by hiding an illness or symptom, we are doing better. In reality, this is not always the case. Asking for help is not a weakness. It is sharing responsibility for the outcome!

Tremor Treatment: Key Questions and Answers

What should I do if I suspect I have a tremor? Which doctor treats tremor?

— First, try to calm down. Tremor can be temporary and related to certain factors: stress, emotions, physical fatigue, and addressing these may alleviate symptoms. Second, note what you associate with the development of the tremor and its duration—this will help you track symptoms more accurately. If the tremor persists for a long time, we recommend consulting a neurologist or Parkinson’s specialist to determine the causes of the tremor.

«Is tremor treatable? — a question often asked by our patients.

— There is no definitive answer. For certain types of tremor (enhanced physiological tremor in thyroid diseases, drug-induced parkinsonism), removing the cause is enough to eliminate the symptoms. Some types of tremor, such as essential tremor, cannot be completely cured; however, with the right medications, the clinical manifestations of the disease can be reduced.

How to treat tremor? How does a doctor choose medication for tremor?

— There are no universal pills for tremor. The doctor prescribes medication for shaking based on objective examination data and medical history (duration of symptoms, presence of adverse clinical manifestations when taking certain groups of drugs, etc.)

What medications can help with tremor?

Beta-blockers (Anaprilin). Side effects: rapid fatigue, slowed pulse, decreased blood pressure (BP), which is why the drug is not recommended for individuals prone to low BP thresholds.

Antiepileptic drugs (Primidone, Gabapentin, Topiramate). Used in patients who show a poor response to beta-blocker therapy. Side effects: drowsiness, sluggishness
Tranquilizers (Clonazepam). Side effects: drowsiness, risk of dependence and habituation.
Botulinum toxin injections. They need to be repeated 2-4 times a year and are most effective for patients with head or voice tremor. Side effects: weakness in the limbs.

What to do if medications for tremor do not help?

If medication therapy is ineffective, it is recommended to consider the possibility of surgical intervention with your healthcare provider.

We discussed surgical treatment methods in a separate article (hyperlink to the article about essential tremor). You can read reviews on tremor treatment using high-intensity focused ultrasound (FUS) at this link.

What can I do to alleviate tremor at home?

Under no circumstances should you start taking medications on your own. Consult a specialist to select the optimal therapy.

Additional treatment methods can indeed help both caregivers of people with tremor and those who suffer from tremor themselves. You can try additional home treatment methods for tremor that may be helpful for symptoms of shaking (Nordic walking, tai chi, yoga, etc.)

Why are my hands shaking? Why does tremor occur? In which diseases does tremor appear?

The appearance of tremor is most often caused by disturbances in those areas of the brain responsible for movement. Most types of tremor are not genetically determined, although there are some forms of shaking that are inherited.

Tremor may appear spontaneously or be a manifestation of other neurological and systemic diseases (Parkinson’s disease, multiple sclerosis, stroke, abscess or tumor brain lesions, psychogenic disorders, tumors of the endocrine glands, diabetes mellitus, thyroid, kidney, and liver pathology)

If I have developed a tremor, does it mean I am ill?

Not necessarily. Sometimes tremor occurs after exposure to certain medications and biologically active substances (corticosteroids, chemotherapeutic agents, heavy metals, organic solvents, caffeine, and other psychoactive substances)

What if hands shake when nervous?

Tremor may occur in stressful situations. It is characterized by a sudden onset with a pronounced emotional reaction, spontaneous disappearance of the tremor, change in the nature of the shaking (amplitude, frequency) when attention is diverted, and gradual disappearance with psychotherapy.

Tremor appears after consuming alcohol. Is it a disease?

After consuming alcohol, sometimes there is a sudden hand tremor against the background of ethanol intoxication.

Prolonged consumption of alcoholic beverages (particularly pure vodka) and binge drinking can lead to chronic tremor. Additionally, sudden cessation of alcohol intake can trigger the development of alcohol withdrawal syndrome—one of the conditions accompanied by pronounced symptoms of shaking, particularly in the hands.

Tremor in the hands. How to live with it?

Tremor or involuntary hand movements, known as tremor, as the underlying disease progresses, cause increasing discomfort. The natural reaction of a person is to hide this ailment from others. Many are led to withdraw into themselves, start avoiding contact… Depression develops, worsening an already difficult condition
However, this unpleasant condition can be alleviated. You can continue to live with minimal discomfort if you internally accept this condition and learn to live with it. Do not side with the illness, do not succumb to despair. Yes, it has already happened. It is irritating and very, very disruptive. But there are ways to take control of the tremor. Your balanced state and desire to control your hands will make the treatment much more effective! Medication alone can help, but you will achieve much greater results by following these recommendations with your doctor.

• Maintain a positive, optimistic attitude and a smile on your face. This will relieve tension and lift your spirits.
• Stress enhances tremor. Use deep breathing exercises or meditation to help reduce stress levels and maintain calmness.
• Learn to use your tremor-free hand for as many tasks as possible
  actions, including writing
• Use the tremor-free hand to steady the shaking hand, and if possible, use both hands.
• When performing tasks, keep your elbows close to your body to help control
  hand tremor
• Use travel mugs with lids.
• Carry straws with you. You can find durable, thick plastic straws in many home goods departments in stores if thin plastic straws are too fragile.
• Avoid caffeine and other medications and herbs containing ingredients that increase heart rate. They can cause a temporary increase in tremor.
• Use and carry weighted handles and utensils with large handles.
• Talk to the people around you about tremor and explain what it is. Awareness fosters mutual understanding.
• Do not be afraid or embarrassed to ask for help. Tell others that you have essential tremor, and ask for assistance in getting products from the top shelves in the store, ask cashiers in cafeterias to help carry your tray to your table, or ask relatives or friends to cut meat or salad for you. It’s absolutely normal!
• Before performing small, detailed tasks with your hands, avoid lifting heavy objects or strenuous work.
• When reading, place the newspaper or book on the table instead of holding it in your hands.
• Carry out tasks slowly. Try to focus and concentrate on
  assigned task

Yes, smiling when your hands stop obeying you is not easy at all. But a smile, even forced, activates internal mechanisms that fundamentally change your attitude toward the illness. And life becomes much, much easier. Be strong and self-ironic—joke about yourself, about the illness. It won’t like it—you’ll see!
And even if medications stop being as effective as before, know this: new, completely safe and highly effective surgical methods have already emerged to help eliminate tremors and involuntary movements—not only of the hands but also of the legs and head.
MRI-guided focused ultrasound is one of these methods. The youngest, but the safest and very effective method. We will discuss it in the following articles.

Summary

Tremor is not a verdict. In choosing a treatment strategy, much depends on how much the tremor limits daily life, social  and professional life, affects   on emotional mood   patient. It is extremely important to choose a professional and competent   team of doctors who  will help you in this life challenge

Consult the professionals, and they will do everything to restore your freedom from tremor

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1. Operations for Tremor

About the Author

Rezida Galimova

The first female neurosurgeon in MRgFUS, one of the founders of the first non-invasive ultrasound tremor neurosurgery center in Russia, Doctor of Medical Sciences, MBA (John Hopkins University), Associate Professor of the Department of Neurosurgery at BSMU.

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