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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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Things worth knowing about "Tremor"

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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