Tremor

What is tremor?

There are several forms of tremor, including:

Essential tremor (sometimes called benign essential tremor) is the most common form of abnormal tremor. The hands are most often affected but the head, voice, tongue, legs, and trunk may also be involved.

Head tremor may be seen as a “yes-yes” or “no-no” motion. Onset is most common after age 40, although symptoms can appear at any age.

Parkinsonian tremor is caused by damage to structures within the brain that control movement. The tremor is classically seen as a “pill-rolling” action of the hands but may also affect the chin, lips, legs, and trunk.

Dystonic tremor occurs in individuals of all ages who are affected by dystonia, a movement disorder in which sustained involuntary muscle contractions cause twisting motions or painful postures or positions.

Is there any treatment?

There is no cure for most tremors. The appropriate treatment depends on accurate diagnosis of the cause. Drug treatment for parkinsonian tremor involves levodopa or dopamine-like drugs such as pramipexole and ropinirole. Essential tremor may be treated with propranolol or other beta blockers (such as nadolol) and primidone, an anticonvulsant drug. Dystonic tremor may respond to clonazepam, anticholinergic drugs, and intramuscular injections of botulinum toxin. Eliminating tremor “triggers” such as caffeine and other stimulants from the diet is often recommended. Physical therapy may help to reduce tremor and improve coordination and muscle control for some individuals. Surgical intervention, such as thalamotomy and deep brain stimulation, are usually performed only when the tremor is severe and does not respond to drugs.

What is the prognosis?

Although tremor is not life-threatening, it can be embarrassing to some people and make it harder to perform daily tasks.

Conditions
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