Do you sometimes feel like your hands are shaking a little? While shaking your hands while holding a cup of tea or trying to write something is normal, sometimes it can be a sign of a more serious condition. This can make you feel uncomfortable, embarrassed, and even stressed. So today, let's talk about this tremor, or what is medically known as `(Tremor)`, in simple terms.
What exactly is Tremor?
Simply put, tremors are involuntary, rhythmic movements of a part of your body that you can't control . They can feel like shaking or twitching. For some people, they may be very mild, while for others, they can be so severe that they can't even perform daily tasks.
This tremor can occur in one or more areas of the body. It is most commonly seen in the hands. However, it can also occur in these areas:
- Hands
- Legs
- Head, neck, or face
- Voice (vocal cords)
- Trunk
In fact, we all have a very small, almost imperceptible tremor in our bodies. This is called ``Physiologic Tremor''. If you hold your hands out in front of you, you will see that they are not completely still. This is normal. However, when you drink coffee, when you are tired, or when you are very anxious, this normal tremor can be a little more noticeable.
A tremor is medically significant when it interferes with your daily life . For example, if it affects your ability to eat, dress, walk, or sign a document, it is something you should be concerned about.
What are the main types of tremors?
Doctors divide tremors into two main types, based on how they occur. To understand this more clearly, see the table below.
| Type of Tremor | How does that happen? (How does it happen?) |
|---|---|
| Resting Tremor | This occurs when a part of the body is completely at rest, without any weight. Imagine you're sitting in a chair, your hand resting on the chair armrest, and your hand starts to tremble, that's this type. |
| Action Tremor | This happens when you use your muscles to perform an action. For example, if your hand trembles when you raise your hand or bring a glass of water to your mouth, it belongs to this type. |
Subtypes of Action Tremor
Functional tremor is further divided into several subtypes:
- Postural Tremor: Tremor that occurs when holding a certain position. For example, when holding the arms out in front of you.
- Isometric Tremor: Tremor that occurs when a muscle is held in a fixed position, without movement. For example, when holding a heavy bag in one position.
- Kinetic Tremor: Tremor that occurs when making a movement. For example, when reaching out and trying to touch your nose.
What could be causing this tremor?
Tremor is a symptom, not a disease, so it can have many causes.
- Alcohol use and withdrawal symptoms.
- Brain tumors .
- Some medications you take.
- Some medical conditions that can be treated. Examples: Overactive thyroid (Hyperthyroidism), Low blood sugar (Hypoglycemia), Calcium or magnesium deficiencies.
- Diseases related to the nervous system, such as Parkinson's disease and Multiple Sclerosis (MS) .
- Stroke .
- Serious head injuries (Traumatic Brain Injuries) .
Some medications that cause tremors
Some medications can cause tremors or increase existing tremors.
- Some medications for asthma (e.g. Albuterol)
- Medications for some mental illnesses (e.g. Lithium, Fluoxetine)
- Atorvastatin for high cholesterol
- Corticosteroids
- Amiodarone for heart disease
Very important: If you are taking this type of medication and have tremors, never stop taking it on your own. Be sure to talk to your doctor for advice.
How does a doctor diagnose this condition?
When you see a doctor with a tremor, he will first ask you a few questions and do a physical examination.
- Did the tremor start suddenly, or did it gradually increase?
- What parts of the body are shaking?
- Does the tremor increase with certain activities or when resting?
- Does it increase with things like coffee and stress, or does it decrease when you focus on something else?
Then, a neurological exam will be performed. This will test your balance and reflexes to find out more about the nature of your tremor.
Several other tests may be done to find the exact cause:
- Blood tests
- Urine tests
- EMG and Nerve Conduction Studies
- CT or MRI scans of the brain
Major Tremor Syndromes
There are several main medical conditions that doctors diagnose based on the pattern of tremor.
| Syndrome | Description and characteristics |
|---|---|
| Essential Tremor | The most common tremor condition. The main symptom is a tremor in both hands when performing an action. There are no other neurological symptoms. It can also affect the head, voice, and legs. |
| Cerebellar Tremor | Usually a slow , large tremor. The tremor becomes worse when you are about to complete an action (e.g., opening a door). It is caused by damage to the cerebellum of the brain. |
| Dystonic Tremor | An irregular, jerky tremor. It may stop when the arm or leg is moved. It is caused by damage to the basal ganglia of the brain. |
| Orthostatic Tremor | Rapid contraction of the muscles in the legs while standing. This stops when sitting or walking. This is a very rare condition. |
| Parkinsonian Tremor | It is seen in more than 70% of Parkinson's patients. It can also be the first symptom. It is most often seen at rest (Resting Tremor). It starts in one arm or side, and can later spread to both sides. |
| Functional (Psychogenic) Tremor | This can be any type of tremor. It starts suddenly. It increases when you focus on it, and decreases when you think about something else. It can be caused by psychological factors. |
What are the treatments for tremors?
Treatment depends on the underlying cause of the tremor. Tremors caused by brain damage are difficult to completely cure. However, tremors caused by medications, drugs, or other medical conditions can often be controlled or cured.
- Essential Tremor: Can be controlled with medications such as Propranolol. In severe cases, treatments such as `(Botox®)` injections or `(Deep Brain Stimulation)` are used.
- Parkinsonian Tremor: Controlled with medications for Parkinson's disease, such as Levodopa.
- Dystonic Tremor: Treatments such as medication, Botox® injections, and Deep Brain Stimulation are used.
- Functional Tremor: Physical therapy and psychotherapy are very important.
Things you can do at home
In addition to medical treatment, you can try these things to make living with tremors easier:
- If things like coffee and alcohol increase your tremors, reduce or stop them.
- Use assistive devices such as special cutlery to make daily tasks easier.
- Choose clothes that are easy to put on, such as clothes with Velcro instead of buttons.
- Reduce stress . Things like meditation and listening to music can help.
- Get enough sleep . Lack of sleep can make some tremors worse.
- Join a support group with people who are going through the same thing as you. It will give you a lot of mental strength.
Anytime you want to see a doctor
If you feel anything like this, definitely see a doctor:
- If the tremor increases over time.
- If it interferes with your daily activities .
- If this makes you feel stressed and anxious.
- If, in addition to tremors , other neurological symptoms (e.g., memory changes, decreased body strength) occur.
It's uncomfortable for anyone to feel like they're losing control of their body. So it's normal to feel scared when you have a tremor. But remember, to find out exactly what's causing it, you need to see a doctor. He or she can run the necessary tests and give you the right treatment plan.
Take-Home Message
- Tremor is not a disease, but a symptom. It can have many causes.
- Not all tremors are a sign of a serious illness, but it is essential to correctly identify the cause.
- If you are taking a medication that causes tremors, never stop taking it without medical advice.
- There are effective treatments to control tremors and manage symptoms.
- If you are concerned about your tremors, do not delay and consult your doctor for advice.
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