A tremor can occur because of various reasons and manifests in different forms. Here you find a selection of different tremor types.
The enhanced physiologic tremor is given, as the name suggests, when the actual physiologic tremor is enhanced. Often the normal physiologic tremor is not visible with the eye and manifests with a high frequency and low amplitude. The enhanced form is visible though the frequency is similar to the frequency of a normal physiologic tremor. The enhanced physiologic tremor can manifest as postural tremor or as rest tremor.
To distinguish it from an essential tremor can be difficult. An evidence for differentiating these tremor types is the high frequency; the enhanced physiologic tremor is seldom lower than 7.5 Hz. This tremor type can also manifest after the intake of medication or other substances like alcohol.
Drug-induced and toxic tremors can occur after the intake of substances (e.g. medication) in many forms. The most common type is the enhanced physiologic tremor; this tremor type can develop after the intake of medication for asthma treatment or antidepressants. Another possibility is the enhancement of a Parkinsonian tremor after the intake of neuroleptics or dopamine agonists. Due to intoxication of substances like lithium, an intention tremor can occur. An intention tremor can manifest after the consumption of alcohol too; during a withdrawal, an enhanced physiologic tremor can occur.
A psychogenic tremor can occur without any physical cause. Most of the time there is a psychological cause behind such a tremor, like a trauma. In former times the psychogenic tremor was called “shell shock” because soldiers, who have returned from war, often had a tremor. The psychogenic tremor can imitate every form of organic tremor, but it is usually possible to differentiate the psychogenic tremor with measurements. About half the patients with a psychogenic movement disorder are suffering from a psychogenic tremor.
The cerebellar tremor has its origin in the cerebellum (Latin, means “little brain”), a region of the brain. Typically, this tremor type manifests as intention tremor. Therefor the words cerebellar tremor and intention tremor are often used interchangeably. The cerebellar tremor occurs after different injuries of the cerebellum, one of the most common causes are lesions in the course of multiple sclerosis. Another cause is a toxic degeneration of the cerebellum due to alcohol abuse. The frequency is usually between 2.5-5 Hz. This tremor type is also one that impedes patients the most in their everyday life because of its form of activation – it can happen that the affected extremity cannot be used anymore.
The Holmes tremor is a very rare tremor type that occurs with some delay after lesions of the brain steam. Months and even years could pass until the Holmes tremor manifests after an injury of the brain. It is characterised by rest, postural and intention tremor that occur simultaneously. The frequency is low (2-4 Hz) and the shaking is mostly less rhythmic in comparison to other tremor types. Because of its three forms of activation, the Holmes tremor impedes patients very often.
Dystonia is a collective term for neurological movement disorders where the muscles contract continuously and uncontrollably. The motor centre in the brain of patients is damaged; the muscle contractions are the consequence. Tremor is a possible symptom of dystonia. The dystonic tremor can manifest in the part of the body that is affected by the dystonia or it can also occur as so-called bilateral postural tremor in the hands.
The orthostatic tremor is very different from other tremor types. This tremor manifests in the legs and often has a high frequency between 13-18 Hz. Because of the shaking, patients have problems with standing. These problems can cause falls too. To compensate for these problems with standing, patients often lean against something or start walking around. The insecurity only occurs while standing, normally walking, sitting and laying are not affected or just in a minimalistic way. Within elderly people it is possible that the problems spread in a light form onto walking too.
At the Wilson’s disease tremor can occur as a symptom. The Wilson’s disease is caused by a genetic defect and patients cannot excrete excess copper, that they absorb via food. The process to degrade copper is impaired and therefor the excess copper accumulates in organs and tissue. Because the brain is affected by the copper accumulation too, the Wilson’s disease can develop similar symptoms like Parkinson’s and dementia. One of these symptoms is rest tremor.
The palatal tremor, also called palatal myoclonus, can occur in two different ways. It is characterised by rhythmic spasms of the soft palate. It can occur as symptomatic palatal tremor after lesions of the brain or as essential palatal tremor without any obvious reasons. The majority of palatal tremors are occurring as the symptomatic type and in general the palatal tremor is very rare. Essential palatal tremor has one very unpleasant discomfort: a clicking-sound in the ears that occurs due of the rhythmic activities of the tensor veli palatini muscle.
At a thyroid overactivity, the so-called hyperthyroidism, tremor can occur as a symptom too. Hyperthyroidism leads to an overproduction of thyroid hormones and thus to an oversupply of the body with these hormones. Due to the oversupply, physical symptoms like excessive perspiration, insomnia, nervousness, restlessness, weight reduction or also tremor can occur.
Tremor can occur as a symptom during hypoglycaemia (also known as low blood sugar). Frequently, patients with diabetes are concerned but also people without diabetes can have low blood sugar. At the hypoglycaemia the sugar concentration in the blood falls to a very low level; that can occur within diabetes patients because of a wrong dose of insulin. Insulin helps to lower the blood glucose level and if the body receives too less carbohydrates the blood glucose decreases. Typical symptoms of hypoglycaemia are for instance dizziness, perspiration, weakness, fatigue, ravenous appetite, irritability, high blood pressure and fast pulse as well as tremor.
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