Introduction
However, involuntary and pathological tremors can also be caused by medication or diseases such as Parkinson’s or essential tremor. Experts refer to the trembling as “tremor”. With a pronounced tremor, even simple tasks such as spooning soup or threading a string can become a challenge. Some sufferers can alleviate the tremor sufficiently well with medication. For many people, however, this approach is not enough and the tremor can lead to such people withdrawing more and more from society, as even a streetcar ride or a visit to a restaurant becomes a gauntlet.
Overview: What is a tremor?
A tremor is an involuntary rhythmic movement of one or more parts of the body. A tremor occurs when opposing muscle groups contract repeatedly. In principle, we tremble a little with every movement without realizing it. If you take your coffee or tea cup in your hand and stretch it forward, you can observe the barely perceptible muscle tremor. This so-called physiological tremor is normal and harmless. As a rule, we only notice a tremor when it is unusually strong.
However, tremor can also be a sign of an underlying illness, and such tremor is often visible and disturbing to outsiders.
How can a tremor manifest itself?
A tremor can be described according to its severity, place of occurrence or, in particular, according to the situation that triggers the tremor.
- A tremor can occur at rest when the arms and legs are supported, when holding the arms forward, for example, or when making undirected or precise movements.
- Postural tre mor: The postural tremor occurs when the affected body part is lifted.
- Action tremor: The movement tremor occurs when the affected body part moves.
- Resting tremor: The resting tremor appears in the resting and supported part of the body, for example the arm resting on the back of the chair.
- Intention tremor: The intention tremor occurs when a part of the body approaches a target.
- Such a tremor can be very pronounced (wild beating) or barely noticeable (fine trembling).
- A tremor can be faster or slower, but usually between 5 and 10 Hz (5-10 beats per second).
- The tremor can occur all over the body or only affect certain parts of the body such as the hands, feet, jaw, head or voice.
Which diseases and deficiency symptoms can cause a tremor?
Certain diseases or deficiency symptoms can cause a tremor. Trembling, for example, is a typical symptom of Parkinson’s disease. The tremor increases as the disease progresses. The characteristic symptoms in Parkinson’s patients are triggered by a deficiency of the neurotransmitter dopamine in the brain. However, we do not know the exact cause of most forms of tremor.
These diseases can cause tremor:
- Parkinson’s disease (tremor in Parkinson’s syndrome)
- Essential tremor (also known as familial or senile tremor)
- Dystonic tremor (tremor in dystonia)
- Copper metabolism disorder(Wilson’s disease)
- Midbrain damage (Holmes tremor)
- Functional (psychogenic) tremor
Which medications and substances can trigger a tremor?
Tremor can also occur as a side effect of various medications and substances. These include, for example:
- Medication for the treatment of depression (antidepressants)
- Medication for the treatment of psychoses (neuroleptics)
- Lithium
- Thyroid hormones
- Medication for the treatment of heart rhythm disorders (antiarrhythmic drugs)
- some blood pressure medication
- Drugs that suppress the immune system (immunosuppressants)
- Drugs for the treatment of cancer (cytostatics, anti-oestrogens)
- Medication for the treatment of asthma (sympathomimetics, cortisone)
- Medication for the treatment of epilepsy (antiepileptic drugs)
- Alcohol
- Coffee
Essential tremor
Essential tremor is also known colloquially as senile tremor. By this we mean a tremor that usually affects both arms and hands, sometimes also the head (yes-yes or no-no tremor). The tremor occurs mainly during movement and when holding, less or not at all at rest, for example when the arms are propped up. This tremor often runs in families and can also occur at a young age, often becoming stronger very slowly over time. Essential tremor is one of the most common forms of tremor.
What are the causes of essential tremor?
The causes are unknown. Researchers suspect that genetic factors play a role in this form of tremor.
Tremor: Diagnosis
Tremor does not always mean Parkinson’s disease. If you suffer from an annoying tremor, it is nevertheless important that you get to the bottom of the cause. In addition to essential tremor, metabolic disorders or medication, for example, can also trigger tremors, and such causes are treatable. We will ask you in conversation,
- whether you regularly take medication and if so, which medication.
- whether family members also suffer from tremor.
- when the tremor occurs.
- where the tremor occurs: do the hands, the feet or the whole body tremble? Does the tremor occur unilaterally or bilaterally?
- whether you have any other complaints: for example, general slowness or unsteady gait.
- whether you have certain illnesses.
- whether you regularly consume alcohol or other drugs and if so, in what quantity.
Your answers help us to narrow down possible triggers. It is also helpful if you can describe the situations in which the tremor occurs.
Tremor: standard diagnostics
This measure is part of the standard diagnostic procedure for tremor:
- a complete neurological examination (here we check nerve functions, sensory organs, reflexes and coordination skills, among other things)
At the USZ, we also measure tremor with a device provided by the ETH, which helps us diagnostically and can make treatment decisions easier.
Depending on the suspected trigger, further examinations may be useful for the diagnosis. These include, for example:
- Blood or urine tests
- electroencephalography (EEG) or
- a magnetic resonance tomography (MRT).
Tremor: treatment depending on the trigger
Whether and how a tremor (trembling) is treated usually depends on the cause and form of the tremor.
Treatment of essential tremor
The first step is to check whether medication can suppress the tremor sufficiently well. These primarily include propranolol, primidone and topiramate. If this medication and, in some cases, other pharmacological alternatives do not work, deep brain stimulation or focused ultrasound can provide a highly reliable remedy. These treatment strategies are effective against almost all types of tremor.
