Tremors are one of the major symptoms of Parkinson’s disease (PD) for many people living with the condition. They can affect either side of the body, impacting arms and hands as well as the head and torso. Tremors can be frustrating to live with, especially when accompanied by other symptoms of PD like slowness, freezing, and loss of balance.
If you have PD, it’s important to understand the different types of tremors and treatments, as well as how tremors caused by Parkinson’s are different from tremors caused by other conditions.
Everyone has some amount of tremor. Physiologic tremors are common, barely noticeable amounts of shakiness that worsen when people are stressed, anxious, or have had too much caffeine. As long as the tremors are not significant and do not affect your day-to-day activities, they may be completely normal.
Even tremors that are not normal are not always caused by Parkinson’s. They can be caused by a range of other conditions, which together are known as movement disorders.
Almost all tremors are either considered action tremors or resting tremors. Action tremors (also known as kinetic, postural, or intention tremors) are tremors that happen the most when you contract a muscle or try to hold a certain position.
Resting tremors, on the other hand, happen when a body part is at rest. Resting tremors are frequently related to PD, but action tremors are more likely to suggest other conditions.
Essential tremor (ET) is the most common movement disorder, affecting about 5 percent of people worldwide. ETs worsen with movement and stress or anxiety, and they gradually worsen over time. They often run in families. These types of tremors most commonly involve the arms and hands, but they can also affect the legs, face, and voice. These are often postural tremors, which means that they are worse when trying to hold a certain position. Treatment may involve medications such as beta blockers (for example, propranolol or primidone).
The cerebellum is a part of the brain that deals with balance and coordination. Cerebellar tremors — also called intention tremors — are unique because they get worse as the affected body part reaches a given target. If you ask someone with cerebellar tremor to reach for and touch a still object, the tremor will typically get worse as their finger approaches that object. They might also miss several times before being able to touch the object. Because the cerebellum also controls balance, people with this type of tremor will often have trouble maintaining their balance, also known as ataxia.
Cerebellar tremors are the most common tremors found in people with multiple sclerosis. An antibiotic called isoniazid, normally used to treat tuberculosis, can help. These tremors can also be caused by strokes or head trauma.
Dystonia is a condition in which uncontrollable muscle contractions occur. Dystonia can lead to involuntary movements like twisting, abnormal and uncomfortable postures, and contractions. These random contractions can look like tremors, so they are called dystonic tremors. Dystonic tremors can be due to Parkinson’s or many other conditions. Dystonia can be treated with local botulinum toxin (Botox) injections to the affected body part.
Many medical conditions can cause tremor due to increased activity in your nervous system (brain, spinal cord, and nerves). For example, people who have high thyroid hormone levels (hyperthyroidism) may experience tremors.
About 70 percent of people with PD will have tremors as a presenting feature. Parkinson’s tremors are typically resting tremors. They are most noticeable when the affected body part (most often a hand or arm) is resting or not in use. Parkinson’s tremors also subside during sleep.
These tremors are often described as “pill-rolling” based on their characteristic motions. People with these types of tremors can look like they are holding a pill between their thumb and first finger and rolling it around continuously. However, it is important to note that tremors can also affect the head, torso, jaw, and lips. The tremor is also typically asymmetric, or only affecting one side of the body.
Symptoms of PD, including tremors, are believed to be due to the degeneration of nerve cells (neurons) in the brain. This degeneration results in low levels of dopamine activity in the parts of the brain that control movement. Dopamine is a neurotransmitter that neurons in the brain use to communicate with one another, especially when controlling movement. That’s why common symptoms of PD include slow and “freezing” movements.
Physical therapy and occupational therapy are health care services that your doctor may recommend for you. With these therapies, you may be able to regain your strength and re-engage with everyday activities, even when living with symptoms of PD.
Because PD is thought to be caused by a shortage of dopamine, first-line medications given for PD tremor are essentially forms of dopamine. The most common is Sinemet (levodopa/carbidopa), which the brain converts to dopamine. Other drugs called dopamine agonists mimic dopamine in the brain.
Like all medications, these treatments may cause side effects. Sinemet can lower blood pressure. It can also lead to a wearing-off effect, whereby tremor and other PD symptoms can return between doses. Talk to your doctor if this happens.
Make sure that you always tell your health care team about any medications or supplements you are taking, as well as any other medical conditions you might have.
For people with PD whose symptoms are not controlled with medications, surgical treatment may be an option. Deep brain stimulation (DBS) is a surgical procedure that uses targeted electrical impulses to help control muscle movement and lessen PD symptoms. In DBS, electrodes are placed into a deep part of the brain. A battery (like a pacemaker) is placed under your skin near your collarbone or in your abdomen to deliver the electric impulses. DBS has been shown to significantly help restore finer muscle control and reduce tremors.
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Are you living with Parkinson’s-related tremors? What treatments or tips have you found to be especially helpful? Share your experience in the comments below, or start a conversation by posting on MyParkinsonsTeam.
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