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.
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.
Some medications and illnesses can also cause tremor. Talk to your healthcare provider before stopping any prescribed medications.
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.
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.
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
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 – 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.
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:
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:
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.
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 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 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
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
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
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.
Let’s take a detailed look at the different types of 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.
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.
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.
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.
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 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.
Your doctor will help ensure that the tremor is not caused by another condition. They can also suggest treatment.
To determine what might be causing your tremor, the doctor will examine you and find out:
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.
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.
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
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!
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
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).
In some cases, brain surgery may be an option for treating severe tremor that does not respond to medication. Such surgeries may include:
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.
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
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:
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:
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
Clothing and accessories . For people without tremor, it is hard to imagine that even buttoning a shirt can be difficult. Tips for reducing shaking:
A very important concern is the ability to write and sign. What to do to make life easier:
Use of Mobile Phones also becomes difficult, especially with the advent of devices where the buttons are only touch-sensitive
Life of a modern person is hard to imagine without the help of a computer. What life hacks can be used:
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.
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.
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.
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!
— 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.
— 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.
— 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.)
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.
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.
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.)
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)
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)
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.
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 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.
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.
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
