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What is Tremor?

Essential Tremor

Essential tremor is a type of uncontrollable shake or tremble of part of the body. 

Most people with essential tremor experience a trembling, up-and-down movement of the hands. 

The arms, head, eyelids, lips and other muscles can also be affected. A tremor in the voice box (larynx) may cause a shaky voice.

Essential tremor is usually more noticeable when you're trying to hold a position or do something with your hands, such as write. It doesn't always affect both sides of the body equally.

Essential tremor is a common movement disorder affecting around four out of 100 adults over 40 years of age. Some people only have a mild tremor at first, which usually gets more severe over time.

Orthostatic Tremor

Orthostatic tremor is a condition that involves the unintentional rhythmic muscle movement of one or more parts of the body.  It usually occurs when a person is standing upright. It is seen as progressive condition.

Dystonia

Dystonia is the term used to describe uncontrollable and sometimes painful muscle spasms caused by incorrect signals from the brain. It is estimated to affect at least 70,000 people in the UK. There are a large number of different types of dystonia which affect people in widely differing ways. Unfortunately there is not yet a cure.

Symptoms of tremor

Essential tremor is considered the most common neurologic movement disorder, and is 8–10 times more prevalent than Parkinson's disease.

Essential tremor is a chronic condition characterised by involuntary, rhythmic tremor of a body part, most typically the hands and arms. 

Essential tremor is considered a slow progressive disorder and, in some people, may eventually involve the head, voice, tongue (with associated dysarthria), legs, and trunk.

However, in many people, the disorder may be relatively non-progressive. The tremor may be mild throughout life.

Identifying tremor

Tremor may be most visible when people maintain a fixed position. In some patients, the tremor may worsen upon performance tasks. People most often describe this feeling as a general "shakiness" or a vibrating sensation in the body. 

Hand tremor may cause difficulties with writing, drinking fluids from a glass or cup, eating, sewing, applying makeup, shaving, or dressing. 

In individuals with essential tremor, the next most frequently affected area of the body is the head, followed by the voice, tongue, legs, or trunk. These tremors may occur in isolation or along with tremor of the hands or arms. People find that tremors usually disappear during sleep.

Psychological and social effects of essential tremor

The psychosocial effects of essential tremor may be embarrassing and debilitating. Essential tremor may eventually affect the patient's ability to perform certain work-related tasks; interfere with activities of daily living; or lead to withdrawal from social activities and interactions due to embarrassment. For some people with essential tremor, other symptoms may also be present such as unsteady, uncoordinated walking.

Diagnosing tremor

To be diagnosed with tremor it is best to see a doctor, who understands tremor, or a neurologist.

There are a number of ways in which tremor can be diagnosed:

  1. The diagnosis will typically begin with the person’s medical history being taken.
  2. The doctor will be looking not only for offending drugs (drugs prescribed for other medical conditions which can cause tremor as a side effect).
  3. The doctor will also ask about the family history.
  4. While the diagnosis of essential tremor remains a visual one, Brain scans Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) may be helpful in eliminating any other conditions which also produce tremor as a symptom.
  5. Blood samples may also be taken to rule out thyroid or copper metabolism problems.
  6. DATScan a diagnostic test can distinguish between essential tremor and tremors of Parkinson's disease.

Types of tremor

There are many different types of tremor that affect people in different ways. The table below shows the different types and characteristics.

Type of tremor
Characteristics

Rest tremor

 

  • Tremor which occurs when the muscles are not being voluntarily moved.
  • Normally when the limb is moved, the tremor will weaken or disappear.
  • Like all tremors, it will get worse when stressed or anxious.
  • Rest tremor is quite separate from other tremors. It is most commonly found in Parkinson's disease.

Action tremor or kinetic

  • A tremor which occurs when the limb or body part is being moved. 

Postural tremor

  • Found when while maintaining a position such as out stretching your arm.

Kinetic tremor

  • Occurs when moving a body part.

Intention tremor

  • Tremor becomes worsens when the limb is guided to move towards a particular body part.

Task specific

  • A tremor which occurs only with specific tasks or activities. 
  • An example of this is primary writing tremor, which occurs mainly when writing.

Idopathic dystonic tremor

  • It occurs in conjunction with dystonia.
  • Dystonic tremor can affect multiple body parts. Most commonly affected are the hands, head and occasionally voice.
  • Dystonic hand tremor is also described as “Writer’s cramp”.

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