Tremors May Be Nothing To Worry About Or Something More Serious But Don’t Let Them Go Unchecked
Do you ever notice that you can’t seem to hold a coffee cup still? Or that your hands sometimes tremble so much it interferes with daily chores? Those involuntary hand movements are called tremors. “They’re common in middle and older age,” says Dr. Chizoba Umeh, a neurologist who specializes in movement disorders at Harvard-affiliated Brigham and Women’s hospital. “They’re not life-threatening, but people with severe tremors may have a hard time feeding themselves, dressing, or driving.”
Not Just A Tremor: 10 Early Symptoms Of Parkinsons Disease Everybody Should Know About Caitlin Marsh
You may know the condition can cause shakes, but would you recognise any other telltale symptoms? Liz Connor asks an expert to explain.
Around 1 in 500 people in the UK are affected by Parkinson’s disease, but many of us are still in the dark when it comes to spotting the signs and symptoms, whether in a loved one or ourselves. It might prompt discussions about assisted living for Parkinson’s.
The neurological condition is caused by a loss of nerve cells in part of the brain called the ‘substantia nigra’. When these vital cells begin to deteriorate, it causes a reduction of dopamine – a chemical that plays a key role in controlling and coordinating movement in the body.
A post shared by Parkinson’s UK on May 2, 2019 at 9:18am PDT
This damage can lead to the telltale tremors that many of us most typically associate with the disease, where the hands, arms, legs, lips, jaw or tongue become shaky when they’re not in use.
However, as Parkinson’s UK points out, it’s not just tremors you need to be on the lookout for.
The condition can actually affect people in a wide range of ways – in fact, there are over 40 possible symptoms – which the charity is on a mission to highlight with their new campaign, Parkinson’s Is.
— Parkinson’s UK April 24, 2019
- Reduced sense of smell
Essential Tremor Vs Parkinson’s Tremors: A Guide To The Major Differences
When people think of Parkinson’sdisease, they may picture the shaking hands commonly associated with thecondition. Persistent shaking of hands and limbs—also known as tremor—can makeit difficult to write a grocery list, hold a cup of tea, button a shirt andapply makeup, among other routine tasks. When tremors interfere with dailylife, it can be very disruptive. While tremors are a hallmark of Parkinson’spatients, there are other diseases similar to Parkinson’s that can causetremors.
Tremors In Parkinsons Disease: What They Are Types Of Tremors And More
Getting the trembling associated with Parkinson’s under control can be a challenge, but treatments can help.
Tremors are a defining characteristic of Parkinson’s disease, affecting about 8 out of 10 people with this movement disorder. Many people think the involuntary shaking motion is the main problem for patients. While it is certainly an irritating symptom that individuals want to get under control, other characteristics of the disease can be more debilitating.
What Is The Difference Between Tremors And Parkinson’s Disease
While the majority of Parkinson’s patients experience tremors,not everyone who has tremors has Parkinson’s. Tremors are also asymptom of other conditions, such as traumatic brain injury, stroke, certainmedicines, alcohol poisoning or anxiety.
Tremor is an unintentional, rhythmic musclecontraction that leads to shaking in one or more parts of thebody. Parkinson’s disease is a neurological disorder that causes tremors,stiffness in limbs and loss of coordination.
The most significant difference between tremor associated withParkinson’s disease and tremor associated with other conditions is thatParkinson’s tremor is typically a “resting tremor,” meaning it ispresent when an individual is at rest and goes away when the individual isactive. Tremors in most other conditions are classified as “actiontremor,” meaning shaking increases when a person is active and decreaseswhen the person is at rest.
While Parkinson’s is typically the most widely-known disease associatedwith tremor, a condition called essential tremor is more common, affectingapproximately 5% of people aged 65 and older.
What Is The Difference Between Essential Tremor Andparkinson’s
The exact cause of essential tremor is unknown while Parkinson’sdisease is better understood.
In Parkinson’s disease, neurons located in the part of the brain thatcontrols movement become impaired or die. These neurons usually produce achemical called dopamine which enables regular body movements. When the neuronscan’t produce necessary levels of dopamine, tremors can occur, along withrigidity of limbs and decreased coordination.
What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinson’s disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didn’t exercise or didn’t start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinson’s, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments — whether medicines or deep brain stimulation — are optimal; and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
What Is A Tremor And What Makes It Different With Parkinsons
Tremor is an uncontrollable, rhythmic muscle contraction that triggers quivering in one or more parts of the body. It often occurs in hands, arms, or legs but can also affect the head, neck, or torso. This shaking may appear in sporadic spells or continue constantly.
The National Institute of Neurological Disorders and Stroke says that age is a risk factor — middle-aged and older adults are more likely to experience tremors.
Parkinsonian Tremor: The Most Common Form Of Resting Tremor
Some patients have a predominant postural tremor in addition to their rest tremor. This form is uncommon and has been considered to be a combination of an ET with PD although the relation between postural tremor that is phenomenologically similar to ET and PD has not been well defined. Further studies are needed to define the relation between ET and other tremors, including PD and other task specific tremors.
Box 3 Clinical Features Suggestive Of Psychogenic Tremor73
Tremor increases with attention, and lessens with distractibility
Responsive to placebo
Absence of other neurological signs
Spontaneous remissions or cures of symptoms
No evidence of disease by laboratory or radiological investigations
Employed in allied health professionals
Litigation or compensation pending
Presence of psychiatric disease
Reported functional disturbances in the past
Commonly, patients with psychogenic tremor often undergo a large number of diagnosis and therapeutic procedures before the final diagnosis is established. A review of medical history in these patients usually shows multiple functional somatic or psychosomatic illnesses. Once the diagnosis is made, most patients continue to have a fluctuating or constant course, followed by improving and progressive periods suggesting the prognosis is far from benign. The therapeutic success is also variable, but the treatment approach should include various combinations of psychotherapy as well as drugs, such as mild anxiolytics and antidepressants. While pharmacological treatment in organic tremor may reduce amplitude, but does not change the tremor frequency, the effect of treatment in psychogenic tremor usually varies from total suppression of tremor, especially when associated with the suggestion of a “cure” to no benefit.26 Interestingly, most of successfully treated patients were young.63
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinson’s disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable – reducing symptoms during “on” periods and no longer controlling symptoms during “off” periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they can’t. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinson’s disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare team’s efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinson’s disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein – glial cell-line derived neurotrophic factor, GDNF – to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinson’s disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinson’s disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinson’s disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinson’s disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinson’s disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
Earlier treatment with levodopa provides symptomatic relief to those with symptoms but does not appear to slow Parkinson’s disease from progressing. Therefore, timing is best determined by symptoms.
The treatment of Parkinson’s disease is complex. Levodopa is the main drug used to reduce tremors and muscle stiffness. Whether it modifies the course of the disease or becomes less effective over time is debated, and it can have side effects, so patients and clinicians sometimes prefer to delay starting treatment.
This Dutch trial involved 445 participants with a recent diagnosis of Parkinson’s disease, enrolled over five years. About half took levodopa for 80 weeks, and half placebo for the first 40 weeks and levodopa for the last 40 weeks. There was no difference in symptoms between the groups at the end of the study.
This evidence supports current guidance to start levodopa when symptoms begin to affect the quality of life and confirm that it has insufficient impact on disease progression to justify earlier treatment.
What Are The Different Categories Or Types Of Tremor
Tremor is most commonly classified by its appearance and cause or origin. There are more than 20 types of tremor. Some of the most common forms of tremor include:
Essential tremor is one of the most common movement disorders. The exact cause of essential tremor is unknown. For some people this tremor is mild and remains stable for many years. The tremor usually appears on both sides of the body, but is often noticed more in the dominant hand because it is an action tremor.
The key feature of essential tremor is a tremor in both hands and arms, which is present during action and when standing still. Additional symptoms may include head tremor without abnormal posturing of the head and a shaking or quivering sound to the voice if the tremor affects the voice box. The action tremor in both hands in essential tremor can lead to problems with writing, drawing, drinking from a cup, or using tools or a computer.
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 tremor and/or increase its severity. Though the tremor can start at any age, it most often appears for the first time during adolescence or in middle age . Small amounts of alcohol may help decrease essential tremor, but the mechanism behind this is unknown.
What Are The Different Stages Of Parkinsons Disease
Each person with Parkinson’s disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinson’s disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinson’s disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
How To Recognize The Signs Of Parkinson’s Disease
This article was medically reviewed by Janice Litza, MD. Dr. Litza is a board certified Family Medicine Physician in Wisconsin. She is a practicing Physician and taught as a Clinical Professor for 13 years, after receiving her MD from the University of Wisconsin-Madison School of Medicine and Public Health in 1998.There are 17 references cited in this article, which can be found at the bottom of the page. This article has been viewed 138,619 times.
Experts say that symptoms of Parkinson’s disease usually start slowly with a tremor in one hand, along with stiffness and slowing movement. Over time, you may develop more symptoms on both sides of your body.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source Parkinson’s disease is a condition where your brain’s nerve cells don’t produce enough dopamine, which effects your motor skills. Research suggests that Parkinson’s disease can be difficult to diagnose because there’s no test for it, so your doctor will likely review your medical records and do a neurological exam.XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source Getting an early diagnosis can help you get the best treatment to help manage your symptoms, so talk to your doctor if you think you might have symptoms of Parkinson’s disease.
What Doctors Look For When Diagnosing Parkinsons
Certain physical signs and symptoms — noticed by the patient or his or her loved ones — are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:
Shaking or tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving
Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
Rigidity: Stiffness in the arms, legs or trunk
Posture instability: Trouble with balance and possible falls
Once the patient is at the doctor’s office, the physician:
Takes a medical history and does a physical examination.
Asks about current and past medications. Some medications may cause symptoms that mimic Parkinson’s disease.
Performs a neurological examination, testing agility, muscle tone, gait and balance.
Causes Of Resting Tremors In Parkinson’s Disease
Resting tremors are among the most noticeable features of Parkinson’s disease .?? The tremors are believed to be caused by complex interactions between a number of factors. Alterations in the activity of several areas of the brain including the substantia nigra, the basal ganglia, and the thalamus, as well as changes in the level and action of the neurotransmitter dopamine, are all related to each other and to the production of the tremors.
Causes Of Resting Tremors In Parkinsons Disease
5 mins readCharacteristics of PD TremorsTremor is one of the characteristic symptoms of Parkinson’s disease , which can lead to communication difficulties, Tremors occur when the person’s limb is resting, Tremors can also affect the jaw or tongue, this begins with the trembling or shaking of one finger, Approximately 70 percent of people experience a slight tremor in one of their hands or feet in the early stages of PD, Parkinson’s disease tremors often start in the fingers or hands with what’s called a pill-rolling motion, As with stiffness, A flutter of a tremor in my left thumb was the first symptom that caught my attention, As with stiffness, arms and head, This typically starts in one hand, Tremors can also affect the jaw or tongue,Tremors associated to Parkinson’s disease are resting tremors, One of the earliest and most widely occurring symptoms of Parkinson’s disease is resting tremors, Hands, Symptoms, Tremors can also affect the jaw or tongue, which occur when the body part is inactive, fingers, These tremors are known as a resting tremor, Occasionally, fingers, arms and head, fingers, and Treatment
4 mins readThere are five main places you’ll have Parkinson’s tremors: 1, Usually, but it is also characteristic of essential tremor , People had discovered there were things that they had
Tremors Not Associated With Parkinsons Disease
There are different types of tremors, of which not all are associated with Parkinson’s disease, and they vary slightly in terms of how, when and where they manifest in the body. They include essential tremor and dystonic tremor and may be associated with other conditions and genetic mutations, although a specific gene has not been identified.
A patient with a Parkinson’s tremor typically will find that their symptoms worsen and spread to other parts of the body over time. Generally, the tremor starts in one hand and can progress to the arm and foot on the same side of the body, and then eventually to the other side of the body. In severe cases, tremors also can affect the jaw or lips.
Which Body Parts Do Parkinsons Tremors Affect
There are five main places you’ll have Parkinson’s tremors:
1. Hands. Parkinson’s disease tremors often start in the fingers or hands with what’s called a pill-rolling motion. Imagine holding a pill between your thumb and index finger and rolling it back and forth.
2. Foot. A Parkinson’s foot tremor is more likely to happen while you’re sitting or lying down with your feet at rest. If the tremor moves into your thigh muscles. It could look like your whole leg is shaking.
Foot tremors disappear when you stand or walk because those are active movements. A foot or leg tremor while you’re standing may be another condition.
3. Jaw. This is common in people with Parkinson’s. It may look like you’re shivering. It can become bothersome if the tremor makes your teeth chatter. If you wear dentures, it could make them shift or fall out.
Chewing eases the tremor, so gum might help.
4. Tongue. It’s rare, but a tongue tremor can cause your entire head to shake.
5. Internal. Some people with Parkinson’s say they can feel a shaking sensation in their chest or abdomen. But can’t be seen from the outside.
Parkinson’s Disease Symptoms: Life Expectancy
Even though Parkinson’s disease is a serious, progressive condition, it is not considered a fatal illness. People who have Parkinson’s disease usually have the same average life expectancy as people without the disease.
But when the disease is in its advanced stages, Parkinson’s symptoms can lead to life-threatening complications, including:
- Falls that lead to fractured bones
Thinking about the progression of Parkinson’s disease can be frightening. But proper treatments can help you live a full, productive life for years to come. And researchers hope to one day find ways to halt the progression of Parkinson’s and restore lost functioning.
Box 1 Clinical Criteria For Essential Tremor2
Definite essential tremor
Postural tremor of moderate amplitude is present in at least one arm
Tremor of moderate amplitude is present in at least one arm during at least four tasks, such as pouring water, using a spoon to drink water drinking water, finger-to-nose manoeuvre, and drawing a spiral.
Tremor must interfere with at least one activity of daily living.
Medications, hypothyroidism, alcohol, and other neurological conditions are not the cause of tremor.
Probable essential tremor
Tremor of moderate amplitude is present in at least one arm during at least four tasks, or head tremor is present.
Medications, hyperthyroidism, alcohol, and other neurological conditions are not the cause of tremor.
Monoamine oxidase inhibitors
ET is believed to be of a central nervous system origin, but a reproducible neuropathology has not been described. A central aetiology was partly supported by the beneficial effect of thalamotomy, thalamic deep brain stimulation , and drugs that act centrally. Numerous experimental physiological and functional imaging studies have also implicated dysfunction in brain stem structures, including the inferior olive, locus coeruleus, red nucleus, thalamus, but cerebellum seems to be a prime candidate for the site of dysfunction in ET.23–25 It is probable that ET occur as a result of an abnormal oscillator of a CNS “pacemaker” in a currently unknown exact location that can be increased or suppressed by reflex pathways.
What Does Current Guidance Say On This Issue
The NICE guideline recommends levodopa as a first-line treatment in the early stages of Parkinson’s to control problems with movement if symptoms are affecting the quality of life. It does not discuss delayed treatment with levodopa.
If motor symptoms are not affecting the quality of life, the guideline recommends considering other drugs such as dopamine or monoamine oxidase inhibitors based on individual circumstances and preferences.
What Are The Symptoms Of Parkinson’s Disease
Symptoms of Parkinson’s disease differ from person to person. They also change as the disease progresses. Symptoms that one person gets in the early stages of the disease, another person may not get until later—or not at all.
Symptoms most often start between the ages of 50 and 60. They develop slowly. They often go unnoticed by family, friends, and even the person who has them.
The disease causes motor symptoms and non-motor symptoms. Motor symptoms are those that have to do with how you move. The most common one is tremor.
Tremor and other motor symptoms
Tremor, or shaking, often in a hand, arm, or leg, occurs when you’re awake and sitting or standing still . It gets better when you move that body part.
- Tremor is often the first symptom that people with Parkinson’s disease or their family members notice.
- At first the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue.
- As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor stays on just one side.
Emotional and physical stress tends to make the tremor more noticeable. Sleep, complete relaxation, and intentional movement or action usually reduce or stop the tremor.
The most common cause of non-Parkinson’s tremor is essential tremor. It’s a treatable condition that is often wrongly diagnosed as Parkinson’s.
Besides tremor, the most common symptoms include:
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinson’s disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Decreased facial expressions: You may not smile or blink as often as the disease worsens; your face lacks expression.
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
Essential Tremor Is Not Parkinsons Disease
Essential tremor and Parkinson’s disease are different conditions. Essential tremor is characterised by shaking when movement starts, which can continue or worsen during movement. The symptoms of Parkinson’s disease include:
- involuntary tremor when you are not moving
- muscle stiffness
- slowness of movement
Parkinson’s disease is caused by a lack of supply of the brain chemical dopamine, which is necessary for smooth and controlled muscular movement.
How Do I Prevent Falls From Common Hazards
- Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
- Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
- Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
- Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
- Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.
Consider Tremor Along With Other Symptoms
“Parkinson’s reputation is that it is a tremor disease, and that’s how you can identify it across a crowded room,” says Rebecca Gilbert, MD, PhD, chief scientific officer for the American Parkinson Disease Association in New York City.
Although tremors bring people to diagnosis in many cases, defining the condition as a tremor disease may have done patients a disservice over the years because there are more severe symptoms that people struggle with. Tremor is just the one that people can see, according to Dr. Gilbert.
“Many think if you don’t have a tremor everything is fine,” she says. “That isn’t true.”
Over time, other disease features, such as cognitive problems, psychosis, blood pressure irregularities, depression, and lack of desire to do things, can be more devastating.
James Beck, PhD, chief scientific officer with the Parkinson’s Foundation, also cautions that tremor may not be the first distinguishing feature.
“A person may notice a slowness of movement called bradykinesia,” he says. “Or someone may be walking down the street and one arm doesn’t swing. These symptoms may appear before tremor.”
While focusing only on tremor may not be advisable, understanding this abnormal movement and treatment options may help patients improve their quality of life.
What Are The Symptoms Of Essential Tremor
If you have essential tremor, you will have shaking and trembling at different times and in different situations, but some characteristics are common to all. Here is what you might typically experience:
- Tremors occur when you move and are less noticeable when you rest.
- Certain medicines, caffeine or stress can make your tremors worse.
- Tremors may improve with ingestion of a small amount of alcohol .
- Tremors get worse as you age.
- Tremors don’t affect both sides of your body in the same way.
Here are signs of essential tremor:
- Tremors that are most obvious in your hands
- Difficulty doing tasks with your hands, such as writing or using tools
- Shaking or quivering sound in your voice
- Uncontrollable head-nodding
- In rare instances, tremors in your legs or feet