What types of tremor are there? | Tremor

What types of tremor are there?

A general distinction is made between rest tremor, i.e. tremor that occurs without physical or mental effort, and action tremor. The action tremor can be divided into a holding tremor and a target tremor. The holding tremor is a tremor that occurs when holding objects against gravity.

The target tremor is a tremor in which the rapid muscle movements occur when the affected person tries to approach a target with his hand. One of the most common types of tremor is the essential tremor, which is usually a holding tremor and in 50% of cases a target tremor. The symptoms increase under stress, decrease briefly under alcohol consumption and are treated with propanolol, for example.

In orthostatic tremor, the muscle twitching occurs mainly after standing for a long time, making the person feel unsteady in their standing position. Other forms include tremor, which occurs in Parkinson’s disease, and psychogenic tremor, which can be caused by psychological problems. Essential tremor is one of the most common forms of tremor.

It is a so-called symmetrical holding tremor, which means that the rapid movements of the muscles occur mainly in situations where, for example, a weight is held with the arms. About half of those affected also suffer from target tremor. This is known as intention tremor, which means that the rapid muscle movements occur when the person concerned tries to approach a target with his or her hand.

This is tested by the doctor through the fingernose test, in which the affected person should lead the finger to the nose and gets stronger and stronger twitches in the hand the closer he gets to his nose. Characteristic for essential tremor is a worsening of symptoms due to stress and a short-term improvement of symptoms after the consumption of alcohol. Essential tremor can usually be diagnosed by clinical examination with various neurological tests, such as the fingernose test.

Therapy focuses on drugs, especially from the group of beta-blockers, such as propanolol. The hand is often affected by tremor, regardless of the cause of the tremor. A tremor of the hand can be fine or rough (small or large movements), fast or slow.

Hand tremor is a major problem for patients because simple everyday things become difficult: Pouring water into a glass or signing a petition can become an unsolvable task, depending on the extent of the tremor. The tremor of the hand can manifest itself as rest tremor, hold tremor (when holding the arms against gravity), action tremor (during arbitrary movements) or target tremor (increase when approaching a target).Even an action-specific tremor, which for example only occurs when writing, is conceivable on the hand. Head tremor is less common than hand tremor and is less restrictive in everyday life than hand tremor.

It manifests itself in an involuntary shaking of the head in a horizontal or vertical direction. The so-called Musset’s sign must be distinguished from head tremor by differential diagnosis. The Musset sign describes a nodding of the patient’s head synchronously with the pulse in the case of severe insufficiency of the aortic valve, which is associated with very large blood pressure amplitudes. This nodding of the head is usually not noticed by the patients themselves; rather, these patients notice a booming of the head due to the high blood pressure amplitude.