Tremors

Overview

Tremors are involuntary shakes or trembling that occur most commonly in the hands, arms, head, voice, teeth, trunk and legs, though they can affect any area of one’s body. The cause of tremors can be relatively harmless, such as a reaction to cold temperatures or fear, or it can be a sign of a more serious underlying neurological disorder, such as multiple sclerosis (MS), Parkinson’s disease, a stroke or brain injury. Withdrawal from toxins such as alcohol, tobacco, drugs or certain medications can also cause tremors.

There are many different types of tremors, with causes ranging from neurological, biological and psychological to environmental. Symptoms can sometimes be alleviated through medications, diet, lifestyle or surgical interventions.

Episodic tremors may be confused with seizures, although they can sometimes also be seen as a symptom of a seizure. Tremors may be seen as a side effect of some antiepileptic medications. 

Risks

There are many causes of tremors, including:

  • Brain, nerve or movement disorders
  • Brain tumor
  • Caffeine
  • Cold temperatures
  • Drugs
  • Excessive alcohol consumption, including alcoholism and alcohol withdrawal
  • Fever
  • Medications
  • Multiple sclerosis
  • Muscle tiredness or weakness
  • Normal aging
  • Overactive thyroid
  • Parkinson’s disease
  • Stress
  • Stroke

Symptoms

Tremors may occur in episodes or various intervals. The most common symptoms of tremors include:

  • Shaking of hands, arms, head, trunk or legs
  • Quivering voice or chattering teeth
  • Nodding of the head
  • Worsens with voluntary movement
  • Worsens with stress or fatigue

Diagnosis and testing

The process of diagnosing tremors begins with a comprehensive evaluation. Diagnosis of movement disorders is based on a clinical exam, a thorough assessment of your personal medical history and a detailed review of your family history. We also use a variety of screening procedures to determine your condition, although there is no single medical test to diagnose tremors. Your doctor will recommend a neurological examination to assess your nervous system and its ability to function properly. You may also undergo laboratory testing to establish if you are being affected by any medications and their side effects, metabolic problems, alcohol in your blood stream and/or levels of certain chemicals in your blood which may be causing tremors.

Other tests, such as brain scans may be ordered by your doctor. Brain scans are imaging techniques used to diagnose a wide range of conditions affecting the brain and may be recommended by your doctor. Types of brain scans include computed tomography (CT scan), magnetic resonance imaging (MRI scan) and positron emission tomography (PET scan).

Treatment

If you are experiencing only mild tremors, you may not require treatment. If you're shaking has increased and you are experiencing difficulty in living your life or accomplishing your daily tasks, your doctor will discuss treatment options with you which may include medications, therapy or surgery.

Medications for tremors may include:

  • Anti-seizure medications
  • Beta blockers
  • Tranquilizers
  • Botulinum toxin

Physical therapy may be recommended to sharpen your coordination, increase your muscle strength and improve your overall ability to control your movements. An occupational therapist may offer solutions to adjust to living with tremors.

If your tremors are severe and extremely disabling, your doctor may discuss with you the option of deep brain stimulation surgery. In this procedure, your surgeon will insert a thin electrical probe into the area of your brain that is causing the tremors. This wire is connected to a device which is similar to a pacemaker. About two weeks after the brain surgery, the pacemakers will be turned on and programming will begin. Many patients experience very rapid improvement in many of their symptoms. Other symptoms can take a few months to improve. The programming of the pacemaker is a very individually tailored experience so predictions of improvement vary based on the type and severity of symptoms being treated. In general, most patients experience significant improvement by six months from the date of the surgery.

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