Tremors

Why am I shaking?

Normally, people are in control of their body movements and can move parts of their body to achieve an immediate goal or perform a task. However, some people face difficulty in performing their day to day activities due to physical problems. The occurrence of tremors in the body is one such problem that hinders normal body function and movement. It often makes people wonder why they or a particular body part is constantly shaking and causing a problem to perform the normal activities.

Parkinson tremor

What are Tremors?

A tremor is an involuntary muscle movement that involves a rhythmic, to and fro movement of one or more body parts. Mostly, tremors affect the hands, but individuals may experience similar effects in their arms, face, voice, trunk and legs. Tremors are not life-threatening and the condition appears among healthy people at large. Many reasons could cause tremors such as the side effects of certain drugs or a symptom of a neurological disorder. The most significant drawback of tremors is that people experiencing it may face embarrassment or face difficulties in performing their daily activities.

Physiological tremors symptoms

Types of Tremors

1. Essential tremor – The tremors are mild and progress slowly. Initially, they start on only one side of the body and within a few years’ time, it spreads to the other side as well. The frequency of the tremor may reduce with age but the severity increases. It is possible to transfer these tremors from parent to child through genes.
2. Cerebellar tremor – The tremor occurs in case of damage or lesions in the cerebellum due to a tumor, a disease or stroke. Lesions in the brain on a particular side force the brain to produce tremors on the same side when the individual moves in any direction to carry out a certain task. Another possibility is the wing beating tremor which includes rest, action and postural tremors. The tremors are most prominent when the person maintains a posture or performs an activity. Speech problems, gait problems, rapid involuntary movement of the eyes may accompany this type of tremor.
3. Dystonic tremor – Dystonia is a movement disorder that involves people having abnormal postures and positions due to involuntary contraction of the muscles. Actions such as twisting of the neck may occur repetitively. The tremors occur when the person moves in a certain way or is in a particular position. The tremors are irregular and can affect any muscle in the body. Touching the affected part of the body can reduce the intensity of the tremor and complete rest is another way to treat the condition.
4. Parkinsonian tremor – Damage to the structures within the brain that control movement causes parkinsonian tremors. It is the first symptoms of Parkinson’s disease and affects the chin, lips, hands, trunk and legs of the individual. Increase in stress or emotions can intensify the tremors. The tremor initially starts in the limbs on one side and then spreads to the other side. This type of tremor usually occurs in people after the age of 60 years.
5. Physiological tremor – The tremor may happen in case of physical exhaustion, hyperthyroidism, the experience of intense emotions, fever, metal poisoning or as an effect of stimulants like caffeine, alcohol, etc. People often fail to notice the tremor with their naked eyes. In case the tremors are a result of a neurological disease or a reaction to certain drugs, the tremor ceases to occur when there is a check on the causes.
6. Psychogenic tremor – The characteristics of the tremor differs from one case to another which may start and stop suddenly. Stress causes an increase in the intensity of the tremors while distracting the person is helpful in limiting the effects of the problem. It is a common opinion that psychogenic tremor accompanies psychiatric diseases and conversion disorder.
7. Orthostatic tremor – Muscle contractions of a rhythmic nature that occurs in the legs and trunk immediately after standing is known as orthostatic tremor. These tremors have a high frequency of occurrence and often cannot be seen. The experience is more like unsteadiness rather than a tremor which stops if the person starts walking, sits down or is removed from the ground.

Tremors Symptoms

• Tremors begin gradually
• May include a ‘yes-yes’/ ‘no-no’ movement of the head
• Emotional stress, fatigue, caffeine and extremities in temperature can aggravate the tremor
• Tremor develops suddenly
• Increase in severity of an existing tremor
• Difficulty in performing day to day activities
• Rhythmic shaking
• Shaky voice

Tremors Causes

• Parkinson disease – This disease affects the nervous system which is responsible for co-ordinate movement of the body parts. It leads to the individual’s loss of control over their physical movements and poses as a difficulty in performing simple daily activities. A person loses grip of his/her hands, they may be unable to control excretion and it also affects their speech.
• Anxiety – It is common for people to ‘shake with fear’ or nervousness. It includes things such as trembling or shaking hands. However, it is not necessarily related to underlying health issues and the tremor subsides when the individual stops thinking about matters related to the cause of the anxiety.
• Stimulants – Consumption of excessive amounts of alcohol or caffeine can affect the body. These substances contain stimulants that affect the neurotransmitters present in the brain. The bodies of the people who are used to having these substances regularly become habituated to it and react accordingly, in such cases the individuals may experience tremors at the time of withdrawal from these substances as well. Tremors during withdrawal occur because the body is not able to cope with an absence of the substance in the system.
• Medication – Some medicines like corticosteroids, amphetamines, etc. that are used to treat psychiatric disorders have some side effects, including tremors. In such a situation a doctor’s opinion is essential to decide whether or not the individual should continue taking the medication or to prescribe alternative medications for the treatment.
• Injury – Any trauma to the brain or damage to the nerves could cause tremors. In some cases the person can recover after a particular point in time, on the other hand, some people face extreme type trauma that has effects that last a lifetime.
• Old age – As people grow old, they become weak and senile. Their muscle and brain coordination also deteriorate. Therefore, tremors often occur in people who are older. However, this shaking movement is of a different nature as compared to the tremors caused because of health problems.
• Genetics – Children of parents who suffer from tremors are 50% more likely to experience the same occurrence. People of one generation can pass tremors, like other traits, to the next generation through genetic material. It is sufficient for only one parent to transfer the defective gene carrying the condition.

Tremors Diagnosis

Examination of:

• Feeling of sensations
• Reflexes of tendons
• Posture and coordination
• Gait
• Muscle strength tone

Blood and urine test to check:

• Metabolic problems
• Chemical levels
• Drug side effects
• Alcohol levels
• Thyroid disease

The doctor may also ask the patient to draw, write or hold something

Tremors Treatment

Medication

1. Beta blockers can provide relief from tremors, but people with asthma and heart problems cannot use this medication.
2. Tranquilizers can treat tremors due to anxiety or tension. They provide mild sedation and should be used cautiously.
3. Anti-seizure medication used as epilepsy drugs can treat tremors. They have short-term side effects like nausea and drowsiness.
4. Botox injections are effective in treating people with head and voice tremors.

Therapy

The therapist teaches exercises to strengthen and increase muscle control. They may also suggest devices that help to adapt to the tremors and perform daily activities with ease.

Surgery

If the tremors are intense and do not respond to medication or therapy, then the doctor may suggest surgery. Deep brain stimulation is done by inserting a long thin electrical probe into the area of the brain that is responsible for the occurrence of the tremors. The wires that are under the skin are connected to a pacemaker-like device. Painless electrical pulses are passed that disrupt the path of the signals causing the tremor.

When to visit a Doctor?

Tremors are not life-threatening, however, they disrupt the normal functioning in day to day life. Therefore, it is important to consult a doctor as soon as the person observes symptoms of tremors to avoid further health complications.