Tremor is most commonly classified by clinical features and cause or origin.
Some of the better known forms of tremor, with their symptoms, include the
following:
Essential tremor (sometimes called benign essential tremor) is the most
common of the more than 20 types of tremor. Although the tremor may be mild and nonprogressive in some people, in others, the tremor is slowly progressive,
starting on one side of the body but affecting both sides within 3 years. The
hands are most often affected but the head, voice, tongue, legs, and trunk may
also be involved. Head tremor may be seen as a "yes-yes" or "no-no" motion.
Essential tremor may be accompanied by mild gait disturbance. Tremor frequency
may decrease as the person ages, but the severity may increase, affecting the
person's ability to perform certain tasks or activities of daily living.
Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may
trigger tremors and/or increase their severity. Onset is most common after age
40, although symptoms can appear at any age. It may occur in more than one
family member. Children of a parent who has essential tremor have a 50 percent
chance of inheriting the condition. Essential tremor is not associated with any
known pathology.
Parkinsonian tremor is caused by damage to structures within the brain that
control movement. This resting tremor, which can occur as an isolated symptom or
be seen in other disorders, is often a precursor to Parkinson's disease (more
than 25 percent of patients with Parkinson's disease have an associated action
tremor). The tremor, which is classically seen as a "pill-rolling" action of the
hands that may also affect the chin, lips, legs, and trunk, can be markedly
increased by stress or emotions. Onset of parkinsonian tremor is generally after
age 60. Movement starts in one limb or on one side of the body and usually
progresses to include the other side.
Dystonic tremor occurs in individuals of all ages who are affected by
dystonia, a movement disorder in which sustained involuntary muscle contractions
cause twisting and repetitive motions and/or painful and abnormal postures or
positions. Dystonic tremor may affect any muscle in the body and is seen most
often when the patient is in a certain position or moves a certain way. The
pattern of dystonic tremor may differ from essential tremor. Dystonic tremors
occur irregularly and often can be relieved by complete rest. Touching the
affected body part or muscle may reduce tremor severity. The tremor may be the
initial sign of dystonia localized to a particular part of the body.
Cerebellar tremor is a slow, broad tremor of the extremities that occurs at
the end of a purposeful movement, such as trying to press a button or touching a
finger to the tip of one's nose. Cerebellar tremor is caused by lesions in or
damage to the cerebellum resulting from stroke, tumor, or disease such as
multiple sclerosis or some inherited degenerative disorder. It can also result
from chronic alcoholism or overuse of some medicines. In classic cerebellar
tremor, a lesion on one side of the brain produces a tremor in that same side of
the body that worsens with directed movement. Cerebellar damage can also produce
a "wing-beating" type of tremor called rubral or Holmes' tremor - a combination
of rest, action, and postural tremors. The tremor is often most prominent when
the affected person is active or is maintaining a particular posture. Cerebellar
tremor may be accompanied by dysarthria (speech problems), nystagmus (rapid,
involuntary rolling of the eyes), gait problems, and postural tremor of the
trunk and neck.
Psychogenic tremor (also called hysterical tremor) can occur at rest or
during postural or kinetic movement. The characteristics of this kind of tremor
may vary but generally include sudden onset and remission, increased incidence
with stress, change in tremor direction and/or body part affected, and greatly
decreased or disappearing tremor activity when the patient is distracted. Many
patients with psychogenic tremor have a conversion disorder (defined as a
psychological disorder that produces physical symptoms) or another psychiatric
disease.
Orthostatic tremor is characterized by rhythmic muscle contractions that
occur in the legs and trunk immediately after standing. Cramps are felt in the
thighs and legs and the patient shakes uncontrollably when asked to stand in one
spot. No other clinical signs or symptoms are present and the shaking ceases
when the patient sits or is lifted off the ground. Orthostatic tremor may also
occur in patients who have essential tremor.
Physiologic tremor occurs in every normal individual and has no clinical
significance. It is rarely visible to the eye and may be heightened by strong
emotion (such as anxiety or fear), physical exhaustion, hypoglycemia,
hyperthyroidism, heavy metal poisoning, stimulants, alcohol withdrawal, or
fever. It can be seen in all voluntary muscle groups and can be detected by
extending the arms and placing a piece of paper on of the hands. Enhanced
physiologic tremor is a strengthening of physiologic tremor to more visible
levels. It is generally not caused by a neurological disease but by reaction to
certain drugs, alcohol withdrawal, or medical conditions including an overactive
thyroid and hypoglycemia. It is usually reversible once the cause is corrected.
Tremor can result from other conditions as well. Alcoholism, excessive
alcohol consumption, or alcohol withdrawal can kill certain nerve cells,
resulting in tremor, especially in the hand. (Conversely, small amounts of
alcohol may help to decrease familial and essential tremor, but the mechanism
behind this is unknown. Doctors may use small amounts of alcohol to aid in the
diagnosis of certain forms of tremor but not as a regular treatment for the
condition.) Tremor in peripheral neuropathy may occur when the nerves that
supply the body's muscles are traumatized by injury, disease, abnormality in the
central nervous system, or as the result of systemic illnesses. Peripheral
neuropathy can affect the whole body or certain areas, such as the hands, and
may be progressive. Resulting sensory loss may be seen as a tremor or ataxia
(inability to coordinate voluntary muscle movement) of the affected limbs and
problems with gait and balance. Clinical characteristics may be similar to those
seen in patients with essential tremor.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Mercury is a naturally occurring element found in water, soil, and the air. Mercury is also contained in some fish, some of the products we use in the home, school, or dentist. Information about sources of mercury exposure, potential health effects, symptoms of exposure, fish that may contain mercury, consumer products that contain mercury, and ways to reduce your exposure to mercury is important for the health of you, and your family.
Alcohol intake by a pregnant mother may result in fetal alcohol syndrome (FAS) in her child. A child with FAS may be hyperactive and have a low IQ, a small head, a growth lag, short eye openings, flattened cheekbones, a short nose, a smooth, thin upper lip, shortening of the fourth and fifth fingers, and a heart murmur.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
Stuttering is a speech disorder characterized by speech disruptions such as prolongations of speech sounds, syllables or words, frequent repetitions, or the inability to start a word. Over 3 million Americans stutter, and boys are more likely to stutter than girls. Stuttering may be developmental, neurogenic, psychogenic, or even genetically determined. Treatment for stuttering may incorporate stuttering therapy with a speech-language pathologist and educating the parents about restructuring the child's speaking environment.
West Nile virus (West Nile encephalitis) is a brain infection caused by a virus. People become infected with the virus after they're bitten by a mosquito that has fed off of a bird that's infected with the West Nile virus. Symptoms in humans include fever, headache, rash, body ache, and swollen lymph nodes.
Ecstasy (MDMA), Rohypnol, ketamine and GHB are a few of the different types of drugs abused at bars, raves and parties. Rohypnol may produce amnesia, GHB may result in sleep, coma, or death, and ketamine can cause dreamlike states and hallucinations. Treatment of club drug addiction focuses on monitoring and managing withdrawal symptoms.
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