Tremors

A tremor is a shaking phenomenon that occurs in one or more areas of your body in a repetitive pattern. It is spontaneous, which means you have no command over it. Muscle contractions are the source of the shaking. Tremors typically involve the hands, although they can also impair the arms, head, vocal cords, chest, and limbs. It might appear and go or be continuous. Tremors can occur by themselves or as a result of another condition. Tremors usually are not a serious disorder, although they can become severe in certain people as they age. Most tremors are difficult to cure, but they usually go off on their own. It's crucial to distinguish between muscular spasms, muscle cramps, and tremors.

Tremors are classified primarily according to when they occur:

Resting tremors

Resting tremors appear when a body component is supported against gravity or is in a resting position. During the activity, tremors are mild or non-existent. They happen at a rate of 3 to 6 cycles per second.

Action tremors

Action tremors occur when the diseased body part moves. Action tremors are also subdivided into the following groups:

Intention tremor

A focused movement, such as putting a finger to the nose, causes an intention tremor.

Postural tremor

You get a postural tremor when you hold a position opposing gravity, such as keeping your arm or leg extended.

Task-specific tremors

Task-specific tremors happen while you're doing something specific, like writing.

Kinetic tremors

Kinetic tremors occur when a body part is moved up and down, such as your wrist.

Isometric tremors

Isometric tremors occur when a muscle contract voluntarily without moving in any other direction.

Physiological Tremor

Physiological tremor is a harmless, high-frequency, low-amplitude positional tremor that affects everyone. It may be magnified by carrying a piece of paper in one's outstretched palm or by directing a laser at a far screen, which is usually invisible to the human eye.

Medical disorders such as thyroid dysfunction, hypoglycemia, certain medicines, or abstinence from alcohol or medications can induce enhanced physiologic tremor in the absence of brain illness. Once the underlying problem is addressed, it is typically reversible.

Several medical conditions can cause tremors such as:

·         Stroke

·         Traumatic brain damage

·         Parkinson's disease 

·         Multiple sclerosis

·         Hyperthyroidism 

The following are some of the most common risk factors for tremor development:

·         Family history

·         Male gender

·         Old age

·         Being Caucasian

·         Physiological tremors

·         Caffeine

·         Stress

·         Low blood sugar levels

·         Muscle exhaustion

The tremor was found to be present in 0.32 percent of the total population, varying from 0.04 percent in those under the age of 20 to 2.87 percent in those over 80 and up. In 2020, the total number of individuals affected by tremors globally was estimated to reach 24.91 million.

Tremors are most commonly felt in the hands. However, it could affect any other body part causing

·         Rhythmic shaking of the hands, limbs, head, feet, or torso 

·         Shaky voice

·         Having trouble writing or drawing

·         Difficulty holding objects

·         Difficulty buttoning shirt

Your doctor will examine the affected area during a medical checkup. However, unless your doctor does more testing, the source of your tremor cannot be determined.

Blood and urine specimens may also be taken to look for evidence of thyroid illness or other medical disorders.

The doctor may perform a neurological examination. This exam will assess how well your nervous system is working.

An Electromyogram, or EMG, may be ordered by your doctor. Muscle contractions activity and muscular reaction to nerve stimulation are measured in this test.

People can learn exercises to increase muscular control, function, and strength coordination from a physical therapist. People with symptoms can work with an occupational therapist to keep doing their everyday activities.

Medications

To help lessen the frequency and intensity of tremors, doctors usually recommend medicines. Among the therapy options available are:

·         Propranolol and other Beta-blockers

·         Antidepressant drugs

·         Primidone and other anti-seizure drugs

Doctors usually recommend disease-specific medications for those with tremors caused by diseases like Parkinson's or multiple sclerosis. If doctors are still unable to pinpoint the origin of the tremors, tranquilizers may be used to help calm the uncontrollable muscular spasms.

Hand tremors caused by an underlying condition like thyroid dysfunction or alcohol withdrawal improve significantly if the underlying issue is addressed.

Certain medicines might cause tremors as a side effect. Tremors are a side effect that should be reported to a doctor if they occur while receiving the medicine. Your doctor will likely change the person's medication dose or prescribe a new one. 

Botox

Botox is a toxin that produces immobility in certain areas. Injections of Botox might help people with speech and neck tremors. On the other hand, Botox injections for hand tremors can cause finger weakness.

Deep Brain Stimulation

Some people may develop a serious tremor that is unresponsive to medicine and negatively influences their quality of life. A doctor may prescribe surgical techniques like deep brain stimulation in such circumstances. A tiny impulse generator is implanted beneath the epidermis in the chest area during DBS surgery. Electrical impulses are sent from the generator to electrodes implanted in the thalamus, which is the area of the brain that coordinates and regulates some spontaneous actions. DBS can be used to relieve tremors caused by essential tremors, Parkinson's disease, or dystonia.

Some individuals may require other procedures, such as 

·         Radiofrequency ablation

·         Radiosurgery

Tremor is not regarded as a life-threatening illness. Tremors might be quite debilitating for certain people, even though many occurrences of tremors are minor. For those with tremors, everyday tasks such as eating, bathing, dressing, and cooking can be challenging. 

In patients with augmented physiologic tremors, the following lifestyle adjustments may assist in lessening hand tremors:

·         Avoidance of strenuous activity

·         Coffee and Recreational drugs are two stimulants to ignore

·         Excessive alcohol intake should be avoided

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 09, 2023.

References

https://www.ninds.nih.gov/health-information/disorders/tremor#:~:text=Tremor%20is%20a%20neurological%20disorder,unintentional%20(involuntary)%20muscle%20contractions.

https://www.mayoclinic.org/diseases-conditions/essential-tremor/symptoms-causes/syc-20350534