Associated symptoms

Since tremor can be a disease in its own right (as in familial essential tremor) but can also be a symptom of another disease, the accompanying symptoms are also different. If tremor occurs in the context of Parkinson’s disease, lack of movement, stiffness, and instability of posture are common accompanying symptoms. In most cases, essential tremor is not accompanied by any accompanying symptoms, but in severe cases, patients may also suffer from gait insecurity, dysmetria (incorrect “measuring” of movements) and intention tremor (tremor increases the closer the patient gets to the object they want to grasp).

The accompanying symptoms of cerebellar damage are nystagmus (eye tremor), disturbed movement coordination with uncertain movement sequences (ataxia) and a speech disorder. Accompanying symptoms in orthostatic tremor are standing insecurity and falls, while in psychogenic tremor there is often a high level of basic tension and psychological overload. Wilson’s disease tremor is accompanied by liver damage and various other neurological symptoms. A tremor in the context of hyperthyroidism is supplemented by the classic symptoms: sweating, unintentional weight loss despite appetite, palpitations, sleep disorders and restlessness are only examples.

Treatment

The treatment of tremor is adapted to the underlying cause. Parkinson’s tremor is improved by treating Parkinson’s disease with L-dopa or with dopamine agonists. A tremor that cannot be controlled with Parkinson’s drugs can be treated by deep brain stimulation, a neurosurgical procedure.

In this procedure, electrodes are inserted directly into the brain in order to suppress the activity of the tremor in the nucleus intermedius ventralis, a core area of the thalamus, by means of controlled electric shocks. A tremor due to hyperthyroidism can disappear with the correct treatment of the thyroid gland. Other forms of tremor caused by fatigue, anxiety, alcohol withdrawal or metabolic disorders can be treated with beta-blockers such as propanolol.

Drug-induced forms of tremor (e.g. theophylline, cyclosporine, cortisone, amiodarone, nifedipine, valproic acid, and neuroleptics) may disappear when the drug is discontinued. If discontinuation of the medication is not possible due to other conditions, this type of tremor may also be improved by a beta-blocker. The very common essential tremor, the cause of which is unknown, but which occurs more often in families, is mainly treated with a beta-blocker or primidone, an antispasmodic drug.

If there is insufficient improvement, benzodiazepines or clozapine are used. Tremor caused by hypoglycemia disappears as soon as the hypoglycemia is corrected by sugary food or drink or glucose infusions.Furthermore, anticonvulsants (from the group of drugs against epilepsy), such as Primidon, are used. If these drugs are not effective enough, other drugs such as gabapentin and topiramate can be given.

In the case of drug resistance (i.e. when the treatment of essential tremor with drugs is not effective), so-called deep brain stimulation can be considered, in which certain parts of the brain are directly stimulated via a neurosurgical procedure. Orthostatic tremor is treated purely symptomatically, which means that the treatment options available cannot cure the disease, but only alleviate the symptoms. The focus here is on drugs such as gabapentin.

In some types of tremor, beta-blockers may be a treatment option. The exact mechanism by which beta-blockers improve the symptoms of tremor is not yet fully understood. What is certain is that beta-blockers indirectly reduce muscle tension and promote blood flow to the muscles.

Essential tremor, for example, can be treated well by beta-blockers in many patients, either as monotherapy (i.e. as a single drug) or as a combination therapy with Primidon. In the body, vitamin B12, together with other substances, fulfils the task of maintaining the functioning of the nerves. It is important to note that vitamin B12 is one of the essential vitamins, which means that it must be taken in mainly with food.

If consumed in sufficient quantities, the symptoms of tremor and rapid muscle movements in tremor can be improved because the nerves are supported in their function. However, care should be taken to ensure that there is not too much vitamin B12. A balanced diet is therefore very sensible.