Symptoms of tremor may be physiological or pathological and can display varying degrees of severity, writes Dr Suneeta Kochhar.

Tremor may be described as involuntary, rhythmic, oscillatory movements. It may be physiological or pathological, with varying degrees of severity.

It may involve the head and neck area, the trunk or the limbs. There may be voice changes or writing difficulties.

Tremor may be caused by pathology affecting the brain stem, the cerebellum and/or the extrapyramidal system.

Physiological tremor may affect both hands equally and may become apparent with anxiety, fatigue, hyperthyroidism, hypoglycaemia, alcohol or other drug withdrawal, and caffeine consumption.

Tremor may be described as having slow or fast oscillations that vary in amplitude.

Clinical assessment

It is important to evaluate tremor by taking a thorough history, which should include its onset and the body part affected.


Management can include avoiding known triggers, such as caffeine and anxiety. Essential tremor may respond to beta-blockers.

Occupational therapy and physiotherapy may be helpful in cerebellar tremors. Specific therapy may be considered in patients who have Parkinson's disease.

For severe tremor, surgical management, such as thalamic deep brain stimulation, may be appropriate.

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