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Tremors are among the major symptoms of Parkinson’s disease. They usually begin on one side of the body and may affect the hands, arms, legs, jaw, or face. Tremors can be frustrating to live with, especially when accompanied by other symptoms of Parkinson’s, such as slowness of movement, freezing, and loss of balance.
If you’re living with Parkinson’s disease, it’s important to understand the different types of tremors and their treatments. It can also help to understand how tremors caused by Parkinson’s differ from tremors caused by other conditions.
Tremors are broadly classified as resting tremors or action tremors. Postural tremor is a type of action tremor.
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Action tremors happen when you voluntarily move or contract a muscle. Types of action tremor include postural, kinetic, intention, and isometric tremors. Action tremors can occur in people with Parkinson’s but can also be associated with other conditions.
Resting tremors happen when a body part is relaxed and supported against gravity. Resting tremor is the type most commonly associated with Parkinson’s, although action tremors can also occur in people with the condition.
A type of action tremor, a postural tremor occurs when you hold a body part in a position against gravity. For example, you might have a postural tremor when you hold your leg or arm up in one position.
Everyone has some degree of tremor, including people without movement disorders like Parkinson’s. Physiologic tremors are normal, usually barely noticeable amounts of shakiness that can become more apparent with stress, anxiety, fatigue, or too much caffeine. These tremors generally aren’t a concern if they don’t interfere with day-to-day activities.
Not all noticeable tremors are caused by Parkinson’s. Tremor can occur on its own or be associated with a range of other conditions.
Essential tremor is a common movement disorder, affecting up to 5 percent of people worldwide. Essential tremors can become more noticeable with movement, stress, anxiety, or fatigue and may gradually worsen over time. They can also run in families.
Essential tremors most commonly involve the arms and hands but can also affect the head, voice, chin, trunk, and legs. Essential tremor is an action tremor and commonly includes postural tremor, which means that it’s worse when trying to hold a certain position. Treatment may involve medications such as the beta-blocker propranolol or the anti-seizure medication primidone.
The cerebellum is a part of the brain involved in balance and coordination. Cerebellar tremor is typically a slow tremor that can occur during purposeful movement and become more noticeable as the affected body part approaches a target.
For example, if someone with cerebellar tremor reaches for an object, the tremor may get worse as their finger approaches it. This type of worsening near a target is called intention tremor. People with this type of tremor may also have problems with coordination, including ataxia, which can affect balance and walking.
Cerebellar tremors can occur with conditions that affect the cerebellum, including multiple sclerosis, stroke, and brain injury.
Dystonia causes sustained or repetitive muscle contractions that can lead to twisting movements and unusual posture. Some people with dystonia also experience tremor, called dystonic tremor.
Dystonia can occur with Parkinson’s and other conditions. Depending on the symptoms and their severity, treatment may include botulinum toxin (Botox) injections into affected muscles.
Many medical conditions can cause or contribute to tremor. For example, hyperthyroidism (an overactive thyroid gland) can cause tremors.
About 70 percent of people with Parkinson’s disease experience a slight tremor early in the disease course. Parkinson’s tremors are typically resting tremors. They’re most noticeable when the affected body part — most often a hand or arm — is resting or not in use.
Parkinson’s tremors often begin in a finger and can also affect the jaw or face. They typically lessen with movement and during sleep.
These tremors are often described as “pill-rolling” based on their characteristic motions. People with this type of tremor may look like they’re rolling a small object between their thumb and first finger. Parkinson’s tremor is also typically asymmetric, affecting one side of the body in early Parkinson’s.
Symptoms of Parkinson’s disease, including tremor, are linked to the degeneration of neurons (nerve cells) in the brain. This includes the loss of neurons that produce dopamine, a chemical messenger involved in controlling movement.
As dopamine-producing neurons are lost, dopamine levels in the brain decrease. These changes contribute to movement symptoms of Parkinson’s, including tremor, slowness of movement, and freezing.
Treatment for tremor in Parkinson’s disease can involve physical or occupational therapy, medications, or deep brain stimulation (DBS).
Physical therapy and occupational therapy are healthcare services that your doctor may recommend. Physical therapy can help you maintain movement and address specific movement challenges, while occupational therapy can help you safely manage everyday activities and maintain independence.
Because many Parkinson’s movement symptoms are related to low dopamine levels in the brain, first-line medications for Parkinson’s tremor include drugs that increase or mimic dopamine.
The most common is levodopa/carbidopa (Crexont, Sinemet). The brain converts levodopa to dopamine, while carbidopa helps more levodopa reach the brain. There is also a continuous subcutaneous (under-the-skin) version called foscarbidopa/foslevodopa (Vyalev) for adults with advanced Parkinson’s who experience motor fluctuations.
Other medications include dopamine agonists, which mimic dopamine in the brain.
Anticholinergics, such as benztropine mesylate, work by blocking the activity of acetylcholine, a brain chemical involved in movement. These medications aren’t as commonly used because of possible adverse effects such as confusion and hallucinations.
Like all medications, these treatments may cause side effects. Levodopa/carbidopa can lower blood pressure. It can also lead to a wearing-off effect, in which tremor and other Parkinson’s symptoms return between doses. Talk with your doctor if this happens.
Always tell your healthcare team about any medications or supplements you’re taking, as well as any other medical conditions you might have.
For some people with Parkinson’s whose movement symptoms aren’t adequately controlled with medication, deep brain stimulation may be an option. DBS can be particularly effective for disabling tremor, wearing-off episodes, stiffness, or medication-induced dyskinesia.
In DBS, electrodes are placed in a targeted area of the brain, and a device similar to a pacemaker is implanted under the skin near the collarbone to provide electrical stimulation. DBS can significantly reduce tremor and other movement symptoms, but it doesn’t cure Parkinson’s.
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Recently I became aware of my lips and jaw experiencing tremors will it stop
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