Brief overview
- Causes: For example, excitement, cold, but also various illnesses (such as Parkinson’s disease, multiple sclerosis, stroke, nerve damage, hyperthyroidism, Wilson’s disease, Alzheimer’s disease, liver failure), alcohol and medication
- Symptoms: Tremor manifests itself through regular, rhythmic muscle contractions. Course varies depending on the type of tremor
- When to see a doctor: If the muscle tremor persists for a long time and there is no obvious explanation for it
- Treatment: Depending on the tremor trigger, e.g. with medication, occupational therapy, brain pacemakers, relaxation exercises
- Diagnostics: Patient interview, physical and neurological examination, blood test, electromyography (EMG), computer tomography (CT), magnetic resonance imaging (MRI), cerebrospinal fluid examination
What is tremor?
The situation is different if the tremor is stronger and makes certain actions more difficult. Then the tremor becomes more significant for those affected. This may already be the case if we are shivering from the cold, our knees are “shaking” from excitement or our muscles are trembling from exhaustion. However, we may also tremble due to a (serious) illness.
Tremor is manifested by involuntary and rhythmic shaking of the head, extremities or the entire body.
Some people suffer from tremor to such an extent that it significantly impairs them in everyday activities such as eating or writing. For others, the tremor is so mild that it has no pathological 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:
- A movement tremor occurs with movements that are performed involuntarily, i.e. not consciously or purposefully, for example drinking from a cup.
- The intention tremor sets in when a very specific goal is targeted, for example when you want to touch the tip of your nose with your finger. In people with intention tremor, the amplitude, i.e. the amplitude of the tremor, increases the closer the hand gets to the targeted object. It is a special form of movement tremor.
A tremor may therefore occur in certain situations, when carrying out a specific activity such as writing (task-specific tremor) or when adopting a certain posture (position-specific tremor).
Tremor is also divided into different forms depending on frequency and intensity:
- Low-frequency, comparatively sweeping tremor with a frequency of less than four “beats” per second (two to four Hz)
- High-frequency tremor, which manifests itself as a fine tremor of up to 15 Hz
Tremor can also be subdivided according to localization: Head, hand or leg tremor.
The different types of tremor include essential tremor, dystonic tremor, orthostatic tremor and psychogenic tremor.
The type of tremor provides the doctor with clues as to the cause of the muscle tremor.
How does an essential tremor progress?
Essential (sometimes also called “essential”) tremor is the most common form of tremor and occurs at any age. Patients with essential tremor may have to change their job due to the tremor or may be unable to work, which means they may have to retire.
Depending on its form, however, tremor can manifest itself in different ways. Examples of this are
- Orthostatic tremor: Typical is a high-frequency tremor of the leg muscles, which is not always visible. The affected person’s stance becomes unsteady. They occasionally also have an unsteady gait with a corresponding tendency to fall.
- Tremor in Parkinson’s disease: Parkinson’s patients mainly suffer from tremor at rest (the tremor occurs, for example, when the hand is resting in the lap). The muscle tremor partially improves during movement.
- Holmes tremor: A slow, non-rhythmic tremor occurs.
- Soft palate tremor: This manifests itself in rhythmic movements of the soft palate (= soft part of the palate).
- Psychogenic tremor: Typically, the tremor only occurs intermittently and to varying degrees. It also subsides when the affected person is distracted.
What are the possible causes?
A special case is so-called psychogenic tremor, which occurs as a result of massive emotional stress. For example, traumatized soldiers may be affected – they used to be called “war tremors”.
Intentional tremor is often caused in the cerebellum, which is why it is also called cerebellar tremor.
Physical causes of tremor
In some cases, a physical illness is the cause of the muscle tremor. Examples are
- Essential/essential tremor: It is not known what triggers it, but a genetic cause is assumed. Essential tremor runs in families, but also occurs without a familial predisposition.
- Orthostatic tremor: The cause of orthostatic tremor is unknown. It may occur as a so-called secondary orthostatic tremor in Parkinson’s disease or after minor damage to the brain stem.
- Dystonia: Disorder in the motor centers of the brain. This leads to pathological, involuntary tensing of the muscles, resulting in incorrect posture. For example, those affected tilt their head unnaturally in one direction (dystonic torticollis). Dystonia is accompanied by a tremor or announces itself as such.
- Hyperthyroidism (overactive thyroid gland): In hyperthyroidism, the thyroid gland produces too many hormones. The result is psychomotor agitation: patients are fidgety, nervous and often exhibit tremors in their fingers.
- Graves’ disease (autoimmune hyperthyroidism): Graves’ disease is an autoimmune inflammation of the thyroid gland. This leads to hyperthyroidism, which may be accompanied by tremors.
- Multiple sclerosis: People with multiple sclerosis also frequently suffer from tremor. This is triggered by inflammation in the patient’s brain.
- In addition, a stroke sometimes triggers a so-called Holmes tremor, which is caused by damage to the transition from the brain stem to the midbrain. Recent research has also linked strokes to the development of Parkinson’s disease.
- Brain inflammation (encephalitis): Inflammation of the brain, for example as a result of a measles, rubella or TBE infection, is associated with damage to the nerve cells. This may trigger a tremor.
- Wilson’s disease: In this disease, the copper metabolism of the liver is disturbed. As a result, the body stores more of the vital trace element 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 loss of memory and thinking ability, the consequences also include motor disorders and tremors.
- Liver failure: The liver is the body’s most important detoxification organ. If it fails, toxic metabolic products accumulate, which may also result in neurological and motor disorders. Tremor is one of the symptoms of liver failure.
- Nerve damage: Nerve damage (neuropathies), such as that caused by toxic substances, diabetes or certain infectious diseases, may also be manifested by tremors. Experts then speak of a neuropathic tremor.
- Palatal tremor (soft palate tremor): It occurs after damage to the cerebellum, among other things (symptomatic soft palate tremor). The cause of essential soft palate tremor is unclear. It is often accompanied by clicking noises in the ear.
- Side effects of medication: Certain medications may trigger a tremor as a side effect. These include, for example, neuroleptics, which doctors use to treat psychosis, and antidepressants, which are used to treat depression as well as obsessive-compulsive disorders, anxiety disorders and panic attacks.
- Poisoning: Heavy metal poisoning (mercury, arsenic, lead, etc.) also frequently causes tremors in addition to other symptoms.
When to see a doctor?
Tremors do not always require medical treatment. However, see a doctor if the muscle tremor persists for a long time and there is no obvious explanation for it, such as fever, shock or cold. The tremor may then be a sign of a (serious) illness that needs to be treated by a doctor.
Tremor: Treatment
Drug therapy
In many cases, tremor (e.g. essential tremor) can be treated with medication, even if a cure is not always possible. For example, the following are used
- Beta blockers: The treatment of essential tremor involves the administration of beta blockers. Doctors also often prescribe these drugs for high blood pressure.
- Anticonvulsants: They are particularly helpful for muscle tremors with a large amplitude.
- L-Dopa: Tremors caused by Parkinson’s are improved by the administration of L-Dopa.
- Botox injections: They help with voice tremor and head tremors in many cases. The botulinum toxin reduces the transmission of excitation to the muscles. In this way, muscle contraction decreases or stops completely.
Brain pacemaker
Occupational therapy
As part of occupational therapy, patients learn how to cope better with the tremor. If the tremor significantly interferes with writing, for example, it may be helpful to take frequent breaks when writing, to write only in block letters or to increase the surface area of the hand. It is easier to cope with tremors when eating if you rest your elbows on the tabletop while eating.
Tremor: What you can do yourself
Even if the muscle tremor is organic, it often increases with mental tension. Relaxation exercises such as autogenic training, progressive muscle relaxation according to Jacobson, yoga or meditation can therefore have a beneficial effect. Learning a relaxation method is therefore very useful for people with tremor.
Tremor diagnosis: what does the doctor do?
First of all, the doctor talks to the patient to find out their medical history (anamnesis). Possible questions include:
- How long have you been suffering from tremor?
- Which parts of your body tremble?
- Does the muscle tremor occur at rest or mainly during movement?
- What is the frequency of the tremor?
- How strong is the amplitude, i.e. how widespread are the tremors?
- Do you have any underlying illnesses (e.g. diabetes, liver disease)?
- Are you taking any medication? If so, which ones?
Examinations
If necessary, the medical history interview will be followed by various examinations – with the aim of identifying certain diseases as the cause of the tremor. These include
- Physical examination: This serves to identify indications of other underlying illnesses. The doctor will focus in particular on symptoms that indicate a hormonal dysfunction such as hyperthyroidism or adrenal gland dysfunction.
- Blood tests: Blood values provide information about liver, kidney and thyroid function, among other things. Blood tests also provide information on 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 EMG, tremor can be precisely documented.
- Magnetic resonance imaging (MRI): This examination, also known as magnetic resonance imaging (MRI), can be used to determine whether the patient is suffering from brain damage – for example after a stroke – or a tumor.
- Computed tomography (CT): This also helps to identify various causes of tremor (such as a stroke).
- Cerebrospinal fluid examination: The doctor takes a sample of the cerebrospinal fluid from the spinal canal (lumbar puncture) to have it examined in the laboratory – for example, if multiple sclerosis is suspected.
Frequently asked questions about tremor
What is a tremor?
A tremor is an involuntary and rhythmic trembling or shaking of a part of the body. It usually occurs in the hands, but can also affect the arms, legs, head or other parts of the body. The most common form is essential tremor, which occurs without a known cause.
Why do you get a tremor?
Tremor occurs when the areas of the brain that control the muscles do not function properly. Triggers include diseases of the nervous system, alcohol or drug abuse or excessive caffeine consumption. Stress and anxiety also cause a tremor. In addition, certain medications can trigger or intensify a tremor.
Which diseases trigger tremor?
Can a tremor be cured?
No, a disease-related tremor cannot usually be cured. However, it can be brought under control with medication, for example, and the symptoms alleviated. In other cases of tremor, such as excessive caffeine consumption, the cause and therefore the tremor can be remedied.
Is a tremor dangerous?
A tremor itself is harmless, but can indicate serious illnesses such as Parkinson’s disease. It also makes everyday activities more difficult, which in turn impairs quality of life. If a tremor occurs, you should seek medical advice to clarify the cause and treat it if necessary.
What is a tremor seizure?
‘Tremor seizure’ is a colloquial term. It means that the shaking, i.e. the tremor, occurs more frequently for a certain period of time. Until the next seizure, however, the tremor decreases again or disappears completely. It increases under stress, for example, and improves during periods of rest.
Essential tremor is the most common form of tremor, which mainly occurs in older people. Stress and emotions intensify this form of tremor. The exact cause is unknown. However, genetic factors appear to play a role.
What can be done to treat tremor?
The exact treatment of tremor depends on its cause. Certain medications for cardiac arrhythmia (beta blockers) or epilepsy (antiepileptic drugs) can reduce the tremor. Targeted exercises, physiotherapy, less caffeine and less stress can also help. In severe cases, deep brain stimulation may be useful. Ask a doctor for advice on what can be done to treat your tremor.