In tremors, the muscles tremor involuntarily, without people being able to influence them. The tremor is often harmless and can be a reaction to too much alcohol, fear, stress, or cold. Sometimes tremors are also behind serious illnesses such as Parkinson's or multiple sclerosis. The symptom can usually be treated well, for example with medication or relaxation.
Tremor plays a role in many diseases, but also in healthy people. The symptom arises when opposing muscle groups involuntarily contract. The fine movements are often barely perceptible to the naked eye and do not affect the person concerned. Experts call this natural and normal tremor physiological tremor.
Due to internal and external influences, such as cold or stress, it intensifies and stands out visually. Everyone knows the tremors at icy outside temperatures or after jumping into cold water, through which the muscles generate heat. However, it is also considered an accompanying symptom in certain diseases, such as Parkinson's disease (Parkinson's disease) or multiple sclerosis. Shivering can also be a side effect of certain medications and can develop as an independent disease.
Medical professionals distinguish between two forms that appear under different conditions:
At the Quiescent tremor the body parts tremble at rest.
At the Action tremor On the other hand, they tremble during various movements, such as holding up the limbs or purposeful movements.
The circumstances in which the tremor occurs provide important clues to the cause and are crucial for the diagnosis. It can also be fast or slow, strong or weak. A wide variety of parts of the body can be affected – from the fingers to the entire body.
At a glance:
Tremor often causes disease or medication
Various causes can be considered for a tremor. These can be harmless and temporary in nature. The tremor can also be serious illnesses that need to be treated.
Possible causes are:
Vitamin B-12 deficiency
Chronic alcohol abuse
Alcohol and drug withdrawal
Consuming too much caffeine
Overworking the muscles
exhaustion
Mental stress, such as stress
Feelings like fear, aggression or anger
cold
pain
Traumatic experiences, such as accidents, physical attacks, war operations that can subsequently trigger tremors (psychogenic tremor)
Tremor as a side effect of medication
For some people, the tremor also results from taking certain medications. Doctors then speak of a drug-induced tremor. The following medicines can cause tremors:
Cancer drugs (cytostatics, anti-estrogens)
Thyroid hormones
Medicines that suppress the immune system (immunosuppressants)
Medicines to treat psychoses (neuroleptics)
Antidepressants
Asthma drugs (sympathomimetics, theophylline, cortisone)
Medicines for irregular heartbeat (antiarrhythmics)
Anti-epilepsy medicines
Some blood pressure medication (antihypertensive drugs)
Shivering as a symptom of illness
Some diseases are associated with the tremor symptom. The most common are:
Parkinson's disease (tremor in Parkinson's syndrome)
Multiple sclerosis (MS)
epilepsy
Hyperthyroidism
Acute renal failure (renal failure)
Liver disorders, such as cirrhosis of the liver, acute liver failure (liver failure)
Disorders of the peripheral nervous system (= affecting the nerve tracts outside the brain and spinal cord), for example polyneuropathy
Diabetes mellitus
Cerebellar disorders
The tremor can also be an independent clinical picture. Then the tremor is not related to illness, medication or other factors. Doctors call this form of tremor essential tremor. The causes of this disease are still largely unclear. However, scientists have identified a genetic (hereditary) component that plays a role in more than half of the patients. It can affect several parts of the body such as hands (mostly), head, voice, face, legs and trunk and can occur as early as adolescence.
Diagnosing a tremor: that's what the doctor does
Always see a doctor if you experience tremors that appear suddenly, inexplicably, are pronounced, and do not go away. Only a doctor can find out whether there is a harmless or serious cause.
At the beginning, the doctor will ask you in detail about your symptoms and your medical history (medical history) in a patient consultation. The following points are of interest to the doctor, for example:
When did you first notice the tremor?
In what situations did the tremor occur? Cold, stress, fear or for no reason?
What parts of the body affect the tremor?
Does the tremor occur at rest or during certain movements, such as holding things, purposeful movements, writing, eating, drinking or speaking?
Are there factors that exacerbate tremor, such as stress?
Are you familiar with underlying diseases, for example a neurological disease, hyperthyroidism, kidney or liver disease?
Do you regularly take medication? If yes: since when and which ones?
Have you had traumatic experiences in the past?
How much alcohol do you drink?
Do you use other drugs?
Are there family members who also have tremors?
Based on your answers, your doctor will get an initial overview of possible causes.
Physical examination: The doctor performs these tests
The physical exam includes certain tests that check for the appearance of the tremor in various conditions. The doctor first wants to know whether it appears at rest, when holding or with certain movements. To do this, first put your hands calmly in your lap: if they tremble, it is a tremor of rest. Then stretch your arms and hands forward at shoulder height, hold them in this position, move them up and down and perform targeted movements: for example, you tap your nose with your finger.
The tests also include certain diversionary maneuvers, such as counting down, or are aimed at certain activities, such as writing. The doctor also records the following parameters:
Type of tremor, such as gross or fine tremor?
Frequency of tremors: the number of rashes is determined every second – is it rare or high-frequency?
Strength of the tremor: Do the movement amplitudes increase when trembling and under what circumstances?
Which parts of the body affect the tremor?
Does the tremor occur on one or both sides?
This is how the doctor classifies the tremor
When resting tremor, affected parts of the body tremble at rest. The doctor distinguishes between action tremors:
Holding tremor: The limbs tremble when you hold them up.
Movement tremor: The tremor starts when the movement is not targeted, for example when the arms and hands are moved up and down.
Intensity tremor: The tremor becomes visible when moving in a targeted manner, for example when you put your finger to the tip of your nose.
Task-specific tremor: The tremor starts in certain activities, such as writing, speaking or playing an instrument.
Further investigations in the event of ambiguities
Further investigations often follow in order to trace the cause. These include:
Blood test (blood count)
Urine test
Electromyography (EMG): examination of muscle activity and determination of tremor frequency (number of tremors every second)
Neurological examinations: The doctor tests, for example, eyesight, eye movements, the sense of balance, movement coordination and reflexes.
In some cases, the following examinations are added:
Magnetic resonance imaging (MRI, magnetic resonance imaging)
Computed tomography (CT)
Examination of nerve water from the spinal cord (lumbar puncture)
Electroneurography (ENG): test for nerve conduction speed
Tremor treatment: medication, relaxation or surgery
Treatment depends on the underlying cause. If a disease triggers tremors, doctors first treat it adequately and try to get it under control. There are some medications that relieve tremor. The choice of the right medicine depends on the form of the tremor:
Holding and action tremor: It dominates, for example, in the "essential" variant (without an independent disease). Doctors use beta blockers such as propranolol, antiepileptics (anticonvulsants) such as Primidon or benzodiazepines. Beta-blockers also help with physiological tremor, which is particularly evident in holding situations and severely affects patients.
Dopaminergic substances (dopamine agonists) and anticholinergics are mainly used for resting tremors (typical Parkinson's tremors).
Doctors inject the neurotoxin botulinum toxin (botox) into task-specific tremors (such as writing tremors, voice tremors), but also with other forms of tremors.
Treatment without medication
A mild to moderate essential tremor that increases with excitement, stress or anxiety helps relaxation techniques. These include, for example, autogenic training or progressive muscle relaxation according to Jacobson. You can learn relaxation training in a course and then easily practice it yourself with a little practice.
If the tremor is very pronounced and the drug treatment is not sufficiently successful, surgery is sometimes useful. People with Parkinson's disease often suffer from very severe tremors. Here, deep brain stimulation is a treatment option in which a neurosurgeon implants electrodes in the brain – a kind of "brain pacemaker".
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