Tremor – Causes, Symptoms and Treatment
Tremor is an involuntary, rhythmic shaking of parts of the body. It most commonly affects the hands, head, or voice and can have many underlying causes.
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Tremor is an involuntary, rhythmic shaking of parts of the body. It most commonly affects the hands, head, or voice and can have many underlying causes.
What is Tremor?
Tremor is the medical term for involuntary, rhythmic muscle contractions that cause visible or perceptible shaking of one or more body parts. The hands are most frequently affected, but tremor can also occur in the arms, legs, head, jaw, or voice. Tremor is not a disease in itself but a symptom that can result from a wide range of conditions.
Types of Tremor
Physicians classify tremor based on when and how it occurs:
- Resting tremor: Occurs when the affected body part is at rest and not being moved. This type is characteristic of Parkinson's disease.
- Action tremor: Occurs during voluntary movement or while maintaining a posture. Includes postural and kinetic tremors.
- Essential tremor: The most common form of tremor, often hereditary, typically occurring during movement and most frequently affecting the hands and head.
- Physiological tremor: A normal, barely perceptible tremor present in all people, which can be amplified by cold, fatigue, or emotional stress.
- Intention tremor: Worsens as the limb approaches a target during deliberate movement; often associated with cerebellar disorders.
Causes
Tremor can be caused by a variety of conditions and factors:
- Neurological conditions such as Parkinson's disease, multiple sclerosis, or cerebellar disorders
- Essential tremor (often familial)
- Overactive thyroid gland (hyperthyroidism)
- Certain medications (e.g., lithium, corticosteroids, bronchodilators)
- Alcohol or drug misuse and withdrawal
- Severe stress, anxiety, or physical exhaustion
- Liver disease (hepatic tremor)
- Excessive caffeine intake
Symptoms and Associated Features
The main symptom is visible or perceptible shaking of a body part. Depending on the underlying cause, additional symptoms may include:
- Problems with coordination
- Muscle weakness or stiffness
- Difficulty speaking or swallowing
- Changes in handwriting
- Impaired fine motor skills (e.g., writing, holding a glass)
Diagnosis
Tremor is typically diagnosed by a neurologist. The following assessments may be used:
- Detailed medical history and neurological examination
- Blood tests (e.g., thyroid function, liver enzymes)
- Brain imaging such as MRI or CT scan
- Electromyography (EMG) to measure muscle activity
- DaTSCAN (dopamine transporter scintigraphy) if Parkinson's disease is suspected
Treatment
Treatment depends on the underlying cause of the tremor:
Medication
- For essential tremor: Beta-blockers (e.g., propranolol), primidone
- For Parkinson's tremor: Levodopa, dopamine agonists
- For tremor associated with anxiety: Benzodiazepines (short-term use)
Non-Medication Approaches
- Physiotherapy to improve coordination and muscle strength
- Occupational therapy to support daily activities
- Deep brain stimulation (DBS) for severe, treatment-resistant tremor
- Focused ultrasound as a minimally invasive treatment option
Lifestyle and Self-Help
- Avoiding caffeine and alcohol
- Stress reduction through relaxation techniques
- Ensuring adequate sleep and rest
When to See a Doctor?
Medical evaluation is recommended if tremor is new, worsening, interfering with daily life, or accompanied by other neurological symptoms. Early diagnosis enables targeted treatment of the underlying condition.
References
- Deutsche Gesellschaft fur Neurologie (DGN) - Guideline on Tremor (2023). Available at: www.dgn.org
- Deuschl G. et al. - The Pathophysiology of Tremor. In: Movement Disorders, 2015.
- World Health Organization (WHO) - Neurological Disorders: Public Health Challenges. Geneva, 2006.
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