A guide to manage tremors

Explain Tremor

One or more bodily parts shake rhythmically and involuntarily during a tremor. This movement disorder can be mild or severe, and it can be continuous or intermittent. Tremors are primarily characterized by involuntary movements that cannot be controlled. Shaking is rhythmic. It usually affects hands, arms, head, legs, vocal cords, and torso. Impact: Can hinder writing, eating, and dressing.

Involuntary movements

Causes

• This can lead to conditions such as Parkinson's, MS, and stroke.
• Excess caffeine, stress, and weariness.
• Tremors can result from some medications.
• Idiopathic essential tremor is a condition for which no known cause has been identified.

Types of Tremors

• A resting tremor occurs when muscles relax.
• The action tremor occurs during voluntary movement.
• Holding against gravity causes postural tremor.
• When reaching for a cup, intention tremors worsen.
• Tremors can be upsetting and burdensome, depending on their severity and place of origin.

Common Tremor Symptoms

• Repetitive, involuntary shaking can affect various parts of the body.
• Shaky hands are the most common symptom, particularly noticeable when writing or handling objects.
• Tremors may cause head nodding or shaking.
• Voice tremor: Shaky voice.
• Fine motor skills: Trouble eating, grooming, dressing, or typing.
• Tension or weariness can worsen tremors.
• Postural instability: Balance and posture can become difficult.
• During deliberate motions like reaching, certain tremors occur.

Affected Regions

• The hands and fingers
• Arms and legs
• Head and face
• Vocal cords
• Body or trunk

There are two types of tremors: Parkinson's and essential tremor.

Parkinson's and essential tremor are distinct.

These are Parkinson's symptoms:

• Parkinson's disease is a progressive neurological illness characterized by hand tremors that occur during rest.
• Involuntary tremors on inactivity, muscle rigidity, delayed movement, and ‘freezing.’
• Parkinson's disease is caused by a deficiency of dopamine, a neurotransmitter that regulates muscle movement.
• Multiple Sclerosis (MS) is an autoimmune condition that causes tremors when a person reaches for something. Possible illnesses

Essential tremor 

• Causes trembling at the onset of movement and can worsen
• Essential tremor is a neurological condition that causes rhythmic shaking of the hands and arms during movement. 
• The head, voice, and legs may also be affected, and factors such as stress, fatigue, and caffeine can exacerbate symptoms. 
• The etiology of essential tremor is unknown, but genetics plays a role in its development. Medication or deep-brain stimulation is used to manage the symptoms of this condition.  

Symptoms

• Action Synergistic tremor: Shaking that occurs during goal-directed activities, such as writing or holding a utensil, tends to intensify afterwards.
• The condition usually affects both hands and arms symmetrically, but it can also impact the head (causing nodding), voice (resulting in a shaky tone), or lower limbs.
• It can start at any age, but it most commonly begins during adolescence or midlife (ages 40 to 50).
• Early tremors are usually minor but tend to intensify over time.

Causes and risks

• Familial tremor occurs in 50–70% of cases of essential tremor.
• The reason for this is unknown, but it is suspected that the cerebellum and other brain regions responsible for muscle coordination are involved.
• Triggers: Stress, exercise, caffeine, and drugs might worsen symptoms

Diagnose and treat

• The neurological test results and the family history indicated the diagnosis. Lab tests rule out other conditions.
• Treatments: Although there is no cure, various therapies can help manage symptoms.
• Medication: Beta blockers are often first-line.
• Assistive devices enhance daily life.
• Tremors can be reduced by the use of botulinum toxin.
• Electromyography (EMG) examinations evaluate muscular electrical activity and rule out other reasons, including x-rays, blood tests, MRIs, and CT scans.
• Surgery options, such as deep brain stimulation or targeted ultrasound, can treat severe conditions when medication is ineffective.

Cause of essential tremor

Essential tremor is more common than Parkinson's disease. According to estimates, one in five individuals aged 65 and older are affected.

A genetic relationship is suspected, although the exact reason for essential tremor remains unknown. Every child of an essential tremor patient has a 50 per cent chance of inheriting it. If multiple family members have essential tremor, the illness is called ‘familial tremor.’ Medication side effects and environmental pollutants, such as mercury, can cause tremors.

Influences on vital tremors

• Some variables worsen it, including:
• Emotional stress • Physical exercise
• Consuming caffeinated drinks can lead to weariness, poor sleep, and alcohol withdrawal symptoms in some individuals.

How essential tremor affect life quality

• Uncontrollable shaking can lower the quality of life in various ways:
• Difficulties with daily tasks, such as writing, dressing, or eating, can lead to frustration, tension, social embarrassment, and exhaustion.

Treatment for essential tremor

The video explains how ultrasound treats tremor

No cure exists for essential tremor. Treatment suppresses involuntary motions. A neurologist can help you choose the best treatment options. 

Options for treatment include:

• Strategies for stress management include avoiding triggers such as alcohol and coffee.
• Some drugs used to treat heart disease, such as beta blockers, and epilepsy, like anticonvulsants, have been effective.
• Treatment options for tremors include medications, deep-brain stimulation, and brain surgery aimed at modifying the affected region of the brain.
• MRI-guided focused ultrasound (not reimbursed by Medicare in Australia) for some essential tremor patients
• If the tremor is mild and doesn't affect daily life, regular monitoring may be the only treatment.
• Alcohol may lessen tremors. Long-term alcohol use is unhealthy; hence, this treatment is not advised.

Essential tremor drugs

If you find your job or daily tasks challenging, your doctor may prescribe medications such as:

• Propranolol is a beta-blocker, while primidone is an anti-seizure medication.
• Alternative treatments
• Physiotherapy or occupational therapy may help your tremor.
• After attempting alternative therapies, your doctor may recommend surgery for severe shaking.
• Surgery for essential tremor may involve 'deep brain stimulation.' Surgery is rarely needed.

Also, read https://patient.info/doctor/history-examination/tremor-pro.

Why are my hands shaking randomly?

Stress, worry, caffeine consumption, neurological illnesses (such as Parkinson's and multiple sclerosis), thyroid issues, and side effects from medications can cause shaking hands. Tremors may occur due to alcohol withdrawal, low blood sugar, or exhaustion. Watch for when the shaking occurs, and consult a doctor if it persists or causes you concern.

Common lifestyle causes

Stress and anxiety can lead to the release of adrenaline, triggering a "fight-or-flight" reaction that results in muscle tension and shaking. This effect can persist in cases of chronic stress.

• Ingesting too much caffeine or stimulants can shake your hands.
• Fatigue: Sleep deprivation might increase tremors.
• When someone quits drinking, they shake.
• Skipping meals can lead to shaking due to hypoglycemia.

Overactive thyroid:

• Hand tremors can result from hyperthyroidism.
• The adverse effects of medication may also contribute to these symptoms. 
• Medications like those for asthma, antidepressants, and steroids can cause tremors. 
• Vitamin deficiencies, like B12 deficiency, can also cause shakiness.

When to consult a doctor.

• For a proper diagnosis, consult a doctor if the shaking is severe, persistent, or interferes with everyday life.
• A doctor can evaluate whether the shaking is transient or a sign of a serious ailment that requires treatment.

Conclusion

If a doctor can diagnose the problem, they can prescribe tests to help determine the best course of treatment.  A tremor is, in and of itself, an uncontrollable movement.  You can regain some control, though, by managing the underlying illness.