tremor

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Tremor is the medical term for muscle tremors. It is a symptom that everyone knows and that starts, for example, when it is cold or exhausted. But it can also occur in connection with many different diseases. In a tremor, opposing muscle groups alternately contract rhythmically. This can seriously affect muscle coordination. Read everything you need to know about the causes, types, and treatment of tremor.

Brief overview

What is tremor? Muscle tremors of varying intensity, sometimes hardly noticeable
Types: according to activity, divided into holding, movement and intention tremors; Differentiated according to frequency and intensity into low, medium and high frequency tremors
Causes: e.g. excitement, cold, but also various diseases (such as Parkinson's disease, multiple sclerosis, stroke, nerve damage, hyperthyroidism, Wilson's disease, Alzheimer's disease, liver failure), alcohol and medication
Diagnostics: Consultation with the patient, neurological examination (including coordination tests, tests of reflexes, sensitivity and eye coordination), if necessary blood tests, electromyography (EMG), computed tomography (CT), magnetic resonance tomography (magnetic resonance tomography, MRT), CSF examination
Treatment: depending on the tremor trigger, e.g. with medication, occupational therapy, brain pacemaker, relaxation exercises

Tremor: description

Trembling is a normal response of the body. The muscles contract involuntarily and usually rhythmically. We always tremble unnoticed. If you hold your hand outstretched in front of you, you can see that your fingers never stand still. This slight tremor of the muscles, medically also called physiological tremor, is quite normal, depending on the state of excitement and is usually not noticed.

It is different when the tremors are stronger and make certain courses of action more difficult. This can already be the case when we are shivering from the cold, our knees are shaking from excitement or our muscles are trembling from exhaustion. But you can also tremble because of a (serious) illness.

Some people suffer from tremors so badly that they are severely impaired in everyday activities such as eating or writing. In others, the tremor is so mild that it has no disease value.

Types of tremor

Doctors differentiate between a resting tremor, which occurs when the corresponding part of the body is relaxed, and a so-called action tremor. The latter can in turn be divided into three categories:

The postural tremor is a natural phenomenon. It shows up when an object has to be held against gravity - for example a drinking glass by an outstretched arm. Two opposing muscles have to work together. Fine-tuning can be difficult, especially when fatigue sets in.
The intention tremor sets in when a very specific goal is approached, for example when you want to touch the tip of your nose with your finger. In people with intention tremors, the amplitude, i.e. the range of oscillation of the tremor, increases the closer the hand comes to the targeted object. It is a special form of movement tremor.
A movement tremor begins with movements that are voluntary, that is, not consciously or purposefully carried out, for example drinking from a cup.

So a tremor can occur in certain situations, when performing a specific activity such as writing (task-specific tremor) or when adopting a certain posture (position-specific tremor).

In addition, the tremor can be divided into different forms depending on the frequency and intensity:

low-frequency, comparatively expansive tremor with a frequency of less than four "swings" per second (4 Hz)
Medium-frequency tremor with tremors from 4 to 7 Hz
high-frequency tremor, which manifests itself as a fine tremor with up to 15 Hz

The type of tremor can provide the doctor with clues as to the cause of the muscle tremors.

Tremor: causes and possible diseases

Muscle tremors are a natural phenomenon. When it's cold, the body generates warmth from movement. Even with physical overexertion, tremors are a normal reaction. Fear, stress or shock can also trigger the muscle twitching.

A special case is the so-called psychogenic tremor, which can occur as a result of massive emotional stress. One example are traumatized soldiers, who used to be referred to as “war tremors”. It is typical that the trembling occurs only intermittently and in different degrees and that it subsides when the person concerned is distracted. An intention tremor often has its cause in the cerebellum, which is why it is also called cerebellar tremor.

Physical causes of tremor

In other cases, a physical illness is behind the muscle tremors. Examples are:

Essential tremor: It is the most common form of tremor and can occur at any age. What triggers it is not known, but it is assumed that there is a genetic cause. An essential tremor occurs in families, but can also occur without a family predisposition. It is noticeable when moving and manifests itself mainly through hand tremors and head tremors. The vocal cords can also be affected by essential tremor.
Orthostatic tremor: A high frequency tremor of the leg muscles, which is not always visible, is typical. The status of those affected becomes uncertain. The cause of the orthostatic tremor is unknown. As a so-called secondary orthostatic tremor, it can occur in Parkinson's disease or after minor damage to the brain stem.
Parkinson's disease: Tremor is a typical symptom of this disease, which is reflected in the German name "shaking paralysis". In those affected, switching points in the brain are damaged, which causes movement disorders and tremors. Parkinson's patients in particular suffer from resting tremors (for example, the tremor occurs when the hand is in the lap). Muscle tremors partially improve as you move.
Dystonia: Dystonia is a disorder in the motor centers of the brain. The result is pathological, involuntary tension of the muscles and the resulting bad posture. For example, those affected tilt their heads unnaturally in one direction (dystonic wry neck, torticollis). Dystonia can be accompanied by or heralded by a tremor.
Overactive thyroid (hyperthyroidism): When the thyroid is overactive, the thyroid gland produces too many hormones. The result is psychomotor restlessness: the patients are fidgety and nervous. Many people experience tremor in their fingers.
Graves 'disease (autoimmune hyperthyroidism): Graves' disease is an autoimmune inflammation of the thyroid gland. This leads to hyperfunction, which can be accompanied by tremors.
Multiple sclerosis: People with multiple sclerosis also often suffer from tremors. It is triggered by foci of inflammation in the patient's brain.
Stroke and its Harbinger Transient Ischemic Attack (TIA): A stroke leaves scars in the brain. Depending on the region of the brain affected, this can result in muscle tremors. In addition, a stroke can sometimes trigger a so-called Holmes tremor, a slow, irregular tremor that is caused by damage to the transition from the brain stem to the midbrain. Recent research has also linked the stroke to the development of Parkinson's disease.
Inflammation of the brain (encephalitis): Inflammation of the brain, for example as a result of measles, rubella or TBE infection, is associated with damage to the nerve cells. This can trigger a tremor.
Wilson's disease: In this disease, the liver's copper metabolism is disturbed. This is why the vital trace element is increasingly stored in the liver, eyes and brain, which leads to functional disorders and tremors.
Alzheimer's disease: In Alzheimer's disease, the nerve cells in the brain degenerate. In addition to a loss of memory and thinking skills, the consequences are also motor disorders and tremors.
Kidney failure with urine poisoning (uremia): If the kidneys no longer work properly, metabolic products such as creatinine and urea accumulate and lead to poisoning. This can lead to neurological and motor failures as well as muscle twitching.
Liver failure: The liver is the body's main detoxification organ. If it fails, toxic metabolic products accumulate, which can lead to neurological and motor disorders, among other things. The tremor is a symptom of liver failure.
Nerve damage: Nerve damage (neuropathies), such as those caused by toxic substances, diabetes or certain infectious diseases, can also be expressed in tremors. Experts then speak of a neuropathic tremor.
Palate tremor (soft palate tremor): A soft palate tremor manifests itself in rhythmic movements of the soft palate. Among other things, it occurs after damage to the cerebellum (symptomatic soft palate tremor). In the case of an essential soft palate tremor, the cause is unclear. It is often accompanied by clicking noises in the ear.
Alcohol abuse: Alcohol is a poison that acts directly on the brain. An overdose will manifest itself the next morning with hangover symptoms such as headache and hand tremors. With long-term alcohol abuse, the tremor is a typical withdrawal symptom.
Drug side effect: Certain drugs can cause tremor as a side effect. These include, for example, neuroleptics, which are used to treat psychoses, and antidepressants, which are used to treat depression, obsessive-compulsive disorders, anxiety disorders and panic attacks.
Poisoning: mercury, arsenic, lead - heavy metal poisoning, along with other complaints, often causes tremors.

Tremor: treatment

Trembling does not always require medical therapy. However, if the muscle tremors persist for a long time and there is no obvious explanation, such as fever, shock, or cold, see a doctor. The tremor may then be a sign of a (serious) illness that needs treatment.

How a tremor is treated in each individual case depends on its cause.

Medical therapy

In many cases, medication can successfully treat tremor, but not always cure it. The following are used, for example:

Beta blockers: An essential tremor can be treated with beta blockers. These drugs are also commonly prescribed for high blood pressure.
Anticonvulsants: They can help especially with large amplitude muscle tremors.
L-Dopa: Shivering caused by Parkinson's disease is relieved by the administration of L-Dopa.
Botox injections: They can help with voice tremors and head tremors in many cases.

Brain pacemaker

In severe cases of Parkinson's disease or essential tremor, the tremor can also be treated with a brain pacemaker. This is planted directly in the brain and interrupts the interfering signals that are responsible for the tremor.

Occupational therapy

As part of occupational therapy, patients learn to deal better with the tremor. Anyone who is significantly disturbed by the tremor while writing, for example, can help to take frequent breaks while writing, to only write in block letters or to enlarge the surface of the hand. You can cope better with the tremors when you eat if you keep your elbows on the tabletop during the entire time you eat.

Tremor: You can do that yourself

Even if the tremor is organic, it often increases with psychological tension. It can therefore be influenced favorably with relaxation exercises such as autogenic training, progressive muscle relaxation according to Jacobson, yoga or meditation. Learning a relaxation method is therefore very useful for people with tremors.

Tremor diagnosis: what does the doctor do?

A tremor can be caused by a wide variety of diseases. In order to get to the bottom of the cause, a whole series of examinations are usually necessary.

First, the doctor will collect his medical history in conversation with the patient (anamnesis). Possible questions are:

How long have you been suffering from the tremor?
Which parts of the body are trembling?
Does the tremor occur at rest or mainly in motion?
What is the frequency of the tremor?
How strong is the amplitude, i.e. how wide are the deflections of the trembling movements?
Do you have any underlying illnesses (e.g. diabetes, liver disease)?
Are you taking any medication? If yes, which?

Investigations

The anamnesis can be followed by various examinations to identify certain diseases as the cause of the tremor. These include:

Neurological examination: Here eye movements, reflexes, sensitivity and coordination are checked, among other things. This is routine when investigating various neurological diseases - from Parkinson's to strokes to multiple sclerosis.
Blood tests: Blood values allow, among other things, a statement about liver, kidney and thyroid function. Blood tests can also reveal certain infections and poisoning.
Electromyography (EMG): This tests the natural electrical activity of a muscle. This provides information about muscle and brain function. With the help of the EMG, the tremor can be precisely documented.
Magnetic resonance imaging (MRI): This can be used to determine whether the patient is suffering from brain damage - for example after a stroke - or a tumor.
Computed tomography (CT): It can help detect various causes of a tremor (such as a stroke).
CSF examination: The doctor takes a sample of the nerve fluid from the spinal canal in order to have it examined in the laboratory (e.g. if multiple sclerosis is suspected).
L-dopa test: the patient is given a dose of the drug L-dopa. If the tremor improves, you may have Parkinson's disease.

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