However you choose to pronounce it—“tree-mer” or “trem-mer”—there’s a “whole lotta shaking’ goin’ on!” I don’t know if Jerry Lee Lewis, who recently died at the age of 87, had a tremor, but during his career, shakin’ was his trademark. His kind of shakin’ was different than most people’s, though. He did it on purpose while those of us afflicted with a tremor(s) do it involuntarily and uncontrollably.
We’ve all seen tremors! Grandpa, who had Parkinson’s disease, had one that made his hands look like they were rolling something he was about to give you. Aunt Mabel had a tremor after she had a stroke. Dad’s hands shook real bad if he drank too many cups of regular coffee, or on Sunday morning if he had too much to drink on Saturday night.
These are all illustrations of the involuntary, rhythmic contraction of muscles that lead to shaking of a part of the body. TREMORS can occur anywhere in the body, but we notice them most when they affect the hands. Picking up objects, buttoning buttons, holding a cup of coffee, or writing are more difficult for folks with tremors. If they affect the vocal cords, the person’s voice is shaky and spastic—volume and pronunciation fluctuate. If they affect the neck, the patients head will shake and rotate side-to-side or forward and backward.
Most tremors are called Benign Essential Tremors. The cause of essential tremors is unknown, but aging of the nervous system is thought to be the cause. They can involve the hands, feet, legs, head, trunk, and vocal cords and are diagnosed when no other cause can be found.
Parkinson’s Disease tremor is easily diagnosed because the patient will also display many of the other symptoms of Parkinson’s. The hand tremor of Parkinson’s is described as “pill-rolling” and has a classic easily recognized appearance. Head tremors are also common in Parkinson’s disease.
Muscle Disorders called Dystonias will be accompanied by Dystonic Tremors. These tremors are more dramatic, coarser, and more twisting, chaotic, and repetitive. A person with cerebral palsy or Huntington’s Chorea will have jerky, unusual muscle activity. Again, these tremors are easy to diagnose because other symptoms and physical findings of the primary disease are also present.
Other tremors are called Physiologic. They are usually temporary and caused by an external source. Examples are as follows:
Caffeine—too much caffeine overstimulates the nervous system and tremors result
Stress—stress produces adrenalin that stimulates sympathetic nervous system causing
tremors, also called Psychogenic
Hypoglycemia—low blood sugar causes adrenalin release with the same reaction
Alcohol Withdrawal—abstinence after long drinking binge will cause tremors
Hyperthyroidism—excess thyroid hormone causes tremors
Prescription Drugs—many have tremors as side effects
Brain Trauma, Neurologic Disorder—abnormal brain stimulus causes tremors
Tremors are diagnosed by observation of the patient. The type of tremor is determined by the presence of typical physical findings, the history of substance abuse, and by excluding other causes. The majority of tremors are age-related Benign Essential Tremors about which little can be done. Eliminating causal factors and taking anti-tremor drugs are the only treatment available, and are of little value. Parkinson’s tremor is sometimes helped by treatment of the other symptoms, eg. carbidopa-levodopa prescribed for movement problems will also often help tremor.
The beneficial effects of therapy have a tendency to “wear off.” That’s either due to the patient developing a tolerance for the drug, or worsening of the tremor. The natural progression of the disease overrides the effect of treatment!
Oral meds like beta blockers, sympathetic nervous system blockers, anti-seizure drugs, tranquilizers, and muscle relaxants all are somewhat helpful. Injections of botulinum toxin, ie. Botox, have been very effective.
Dr. G’s Opinion: I’ve had a benign essential tremor for at least 15 years. I have taken a beta blocker for it, but despite that, it has steadily gotten worse. My biggest problems are buttoning buttons, holding the communion cup in church, and using small instruments (eg. screwdriver). Eating soup is quite challenging, and handing out a single piece of paper from a stack is nearly impossible. My tremor stems from an episode of thyroiditis I had in 2007. That triggered it and time and age have prevented it from going away.
If you have a tremor, be sure to see your doctor and rule out treatable causes. Tremors are sometimes very bothersome, but there are worse things. Tremors are not associated with fatal illnesses, but Parkinson’s Disease, Huntington’s Chorea, and Cerebral Palsy are very debilitating and life-altering disorders. The tremor of these diseases is a minor problem compared to the other symptoms seen in these patients.
References: https://www.healthline.com/tremor
Elias WJ, Shah BB. Tremor JAMA 2014 Mar 5;311(8):948-954.
Kamble N, Pal PK. Tremor Syndromes: A Review Neurol India 2018 Mar-Apr;66:S36-S47.
Louis ED. Tremor Continuum (Minneapolis Minn) 2019 Aug;25(4):959-975.
Louis ED. Diagnosis and Management of Tremor. Continuum (Minneapolis Minn); 2016 Aug;22:1143-1158.
Elble RJ. Tremor Disorders Curr Opin Neurol 2013 Aug;26(4):413-419.
