Tremor is the medical term for involuntary and not controllable shaking and the most common movement disorder in the world. The word “tremor” is Latin of origin; the word “tremere” means “shaking”. A tremor develops when counteractive muscle groups contract involuntarily.
Every human has a so-called physiologic tremor. The physiologic tremor is a shaking that is not or just barely visible to the human eye.
This shaking can increase for a short time (e.g. due to nervousness, coldness, anxiety, too much caffeine…) but the physiologic tremor is normal and not pathologic. Mostly the physiologic tremor manifests with a high frequency and a low amplitude, that means the shaking is fast but not that severe.
The hand tremor is certainly the most known form of tremor but not only the hands can be affected by the shaking: the legs, the arms, the head, the tongue or the soft palate can shake too.
Tremor can manifest in different forms and can occur in various situations. In general, there are two major forms of tremor: the rest tremor and the action tremor.
Typical for the rest tremor is that the shaking starts as soon as the affected body parts are in a rest position, e.g. the hands are laying in the lap. As soon as a movement is implemented the tremor vanishes. But not only the common hand tremor can occur as a rest tremor, there are some other sub forms like the head tremor, the palatal tremor and the pill rolling tremor. Characteristic for a pill rolling tremor are the constant opening and closing movements of the fingers.
As the name suggests, the action tremor occurs when an action, means a voluntary movement, is implemented. For action tremor too there are various sub forms, e.g. the postural tremor or the intention tremor. Characteristic for the postural tremor is the shaking that starts when the affected hand holds an object, e.g. a glass. The intention tremor is characterised by shaking that starts if a specific movement is implemented, e.g. reaching for a glass.
Get more information about different tremor types
Enhanced tremor is a symptom of different diseases. A very well-known disease, where tremor can manifest as a symptom, and that people often immediately connect to shaking, is the Parkinson’s disease. If the tremor occurs isolated and no other disease is the cause of the shaking, medical experts call it essential tremor. The essential tremor is much more widespread than the Parkinson’s Disease.
Pathologic tremor types are often not comparable anymore with the normal physiologic tremor – a pathologic tremor has more force, is visible and present permanently. Such a distinctive tremor can impose a restriction in everyday life of the patients. Many daily activities like drinking, eating, writing or using a computer can be very challenging with shaking hands.
The possible stigmatisation of tremor patients by fellow human beings can be very onerous. Therefor it is not uncommon that tremor patients retreat and try to avoid situations where others could see their shaking (e.g. eating out).
If someone realises that they have a permanent shaking and the shaking starts without any obvious reasons (e.g. cold or similar) a visit at a doctor is advisable. The doctor can identify if the tremor is still in its normal physiologic range or if the shaking is pathologic.
First steps towards the clarification are the survey of symptoms and a look at the medical history of the patient. Doctors often ask about how often the tremor occurs, which body parts are affected, in which situation the shaking starts (in rest position, during movements), if there are potential triggers and if something increases or decreases the tremor (e.g. alcohol, lack of sleep, caffeine, stress).
Within some medication, tremor can occur as side effect (e.g. beta-agonist to treat asthma). Another important fact for doctors is if other family members also suffer from tremor.
As soon as the evaluation of the patient’s medical history is finished, the seeking for causes starts. Tremor can have various causes and therefor two parameters are important for the evaluation of tremor: the tremor frequency and the tremor amplitude.
The tremor frequency can give hints about possible underlaying diseases. In medicine, tremor is divided into low, middle and high frequencies. Different tremor diseases have different frequency ranges; that means different speeds of tremors.
The tremor amplitude shows how severe a tremor has manifested. The amplitude is also divided into three groups: coarse, medium and fine. It can give a hint about how a medication or therapy method influences the tremor. If the force of shaking is decreasing, the therapy or medication affects the tremor positively; if it stays the same or increases, another therapeutic approach has to be considered.
Read more about tremor parameters and the measurement parameters of the Tremipen®
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