Tremor

Getting the tremor under control

When your hand becomes less steady and eventually begins to tremble, it is an unmistakable sign of ageing. Sometimes, our hands shake for other reasons, such as cold, fear or too much coffee. However, a clearly visible tremor can also be a symptom of a disease or even the disease itself. It can also occur in patients over the age of 20 years.

At Schoen Clinic, we specialise in diseases of the nerves and brain. We can treat your tremors well using effective therapies. The earlier, the better.

Causes & symptoms

What is a tremor?

A tremor is actually a movement disorder. It most often occurs in the hands or arms, but the torso or the head can also be affected. At least one in every hundred people in Germany suffers from an essential tremor, i.e. a tremor without a recognisable neurological disease. When it comes to this form, several members of the family are often affected. The tremor intensifies when the muscles are tense, i.e. when you want to write, drink or eat. It is exactly the other way round in Parkinson’s patients. Here, the tremor decreases when you do activities.

A tremor can occur in different situations:
  • Resting tremor:
    It occurs when the muscles are completely relaxed, for example when your hand is lying on a table. If the affected person has to concentrate on an upcoming task, the tremor usually intensifies. A resting tremor is typical of Parkinson’s disease.
  • Action tremor:
    There are three subtypes of tremor: postural tremor, kinetic tremor and intention tremor.
    A postural tremor always occurs when the affected person needs strength to hold a finger, arm or leg in position. Trembling when holding a glass of water is typical of this. A postural tremor is a characteristic of an essential tremor, but also occurs in Parkinson’s patients.
    A kinetic tremor appears with certain movements. For example, it impedes writing or playing the piano. A kinetic tremor is also typical of an essential tremor.
    In an intention tremor, tremors increase when the target of a particular movement is reached or “within reach”. This happens, for example, when a finger is led towards a certain point.

Causes: How does a tremor develop?

There are several reasons for tremor.

Intensified physiological tremor

This tremor usually affects the hands and occurs mainly as a postural tremor. The tremor is clearly visible, but is usually not perceived as disruptive. The cause can be a variety of diseases, such as an overactive thyroid or parathyroid glands, calcium deficiency, hypoglycaemia or vitamin B12 deficiency. Kidney function disorders, stress, fatigue, cold or medication can also cause the tremor.

Parkinsonian tremor

During the course of the disease, neural pathways in the midbrain are the cause of the movement disorder.

Essential tremor

Research results so far indicate that a nervous control circuit between the cerebellum, brainstem and midbrain is disturbed. When neurosurgeons or accidents interrupt the corresponding control circuit, the tremor disappears.

Symptoms: Indications of a tremor

There can be several signs of tremor.

Symptoms of an intensified physiological tremor

A high frequency of shaking movements is typical here. If the cause of the tremor is found and resolved, the tremor will subside by itself.

Symptoms of a Parkinsonian tremor

The typical tremor in Parkinson’s patients is a resting tremor. A postural tremor can sometimes also occur. The tremor particularly affects the feet and hands, but rarely the head. The tremor sometimes also affects the jaw and tongue.

Symptoms of an essential tremor

An essential tremor mainly affects the hands and arms. It often starts with a slight tremor in the dominant hand, then both hands are affected later on. Writing becomes increasingly illegible, eating and drinking become more and more difficult. If the head, voice or facial muscles are affected, communication problems often arise. The symptoms can also get worse under stress. Many sufferers then increasingly withdraw from their social environment. The progression of the illness varies from person to person. Some suffer from a slight tremor at an early stage, which then remains for life. In others, the symptoms start late and increase rapidly. Particularly in the late stages, it can also lead to cognitive disorders and personality changes. When the tremor affects the legs, patients feel very unsteady when standing. In the beginning, they still try to compensate for the unsteadiness by frequently switching to the other leg or seek a means of support. Over the course of the illness, standing unaided becomes impossible and falls become frequent.

CAUTION

If you drink moderately, the symptoms improve over the short term for about three to four hours. But if the alcohol in the liver is broken down, the tremor becomes worse. It is therefore best to avoid alcohol.

Diagnostics

How we diagnose a tremor

To get to the root cause of your trembling, our consultants first observe whether it is a resting, postural or kinetic tremor. During this, you are instructed to perform certain activities, such as bringing a cup to your mouth and holding it there. If an uncontrolled tremor of the hands occurs, it is an essential tremor. However, a writing test also gives us information about which form of tremor you are having. Further indications are provided by the frequency of the movement. It is generally lower in a Parkinsonian tremor than in other tremor forms.

Further examinations for a reliable diagnosis

If an intensified physiological tremor has been diagnosed, we use laboratory tests to determine the underlying metabolic disorders. Aa neurological or internal medical examination can sometimes provide the crucial clues.