What are tremors?
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 the body. There are many different types of tremors. Their 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.
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
There are many causes of tremors, including:
- Brain, nerve or movement disorders
- Brain tumor
- Cold temperatures
- Excessive alcohol consumption, including alcoholism and alcohol withdrawal
- Multiple sclerosis
- Muscle tiredness or weakness
- Normal aging
- Overactive thyroid
- Parkinson’s disease
Episodic tremors may be confused with seizures, although they can sometimes also be seen as a symptom of a seizure.
How is it diagnosed?
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).
Types of treatment
If you are experiencing only mild tremors, you may not require treatment. If your shaking has increased and you are experiencing difficulty in accomplishing your daily tasks, your doctor will discuss treatment options with you which may include diet/lifestyle changes, medications, therapy or surgery.
- Medications for tremors may include:
- Anti-seizure medications
- Beta blockers
- 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.