Tremor

What is tremor?

A tremor is an involuntary, regular, rhythmic oscillatory movement resulting from alternating contractions of antagonistic muscles. It can be normal (physiologic) or abnormal (pathologic). A tremor preferentially affects fingers and hands, the head, tongue, jaw, and rarely the trunk.

Major types of tremors include those that are present at rest (Parkinsonian tremor), tremor occurring during the last part of voluntary movement that requires fine adjustments of the movement (intention, ataxic or cerebellar tremor), postural or action tremor that is enhanced by anxiety, fright, alcohol withdrawal, exercise, fatigue, inherited essential or familial tremor, or, if it becomes evident only in late adult life (senile tremor), orthostatic tremor affects legs during standing, tremor of neuropathy affects hands, and, finally, tremors of mixed type.

How is it diagnosed?

History: Individual complains of involuntary shaking of different body parts, such as hands, fingers, legs, feet, limbs, trunk, head, lips or tongue. Depending on underlying disorder, additional symptoms may be present.

Physical exam: In addition to different types of tremors, rigidity, mask-like face, and other clinical signs can be detected.

Tests: Electromyographic (EMG) studies are indicated.

How is tremor treated?

Depending on the type of tremor, various centrally acting agents are used. Brain microsurgery is sometimes indicated.

Medications

Information	Brand	Generic	Label	Rating
	Neurontin	Gabapentin

Nydrazid (Isoniazid), Topamax (Topiramate), Remeron (Mirtazapine), Xanax (Alprazolam)

What might complicate it?

Anxiety, emotional stress, alcohol, and some medications can aggravate the tremor. Other complications depend on the underlying disorder.

Predicted outcome

The tremor can seriously affect the individual's quality of life. It is usually a chronic and progressive disorder, and involvement of additional body parts may be expected. On the other hand, enhancement of physiologic tremors that occur in various metabolic and toxic states is temporary.

Alternatives

Multiple sclerosis, Wilson's disease, stroke, side effects of antipsychotic medications, meningoencephalitis, and certain intoxications are other diagnostic possibilities.

Appropriate specialists

Neurologist.

Last updated 21 December 2011