Signs & Symptoms: Is It Essential Tremor Or Parkinsons
In order to start managing your condition and receive the treatment you need, you should be aware of the most common signs and symptoms as well as the key differences between essential tremor and Parkinsons. After all, the first step in getting care as early on as possible is self-awareness that you might be suffering from one of these conditions.
What Causes Tremors Besides Parkinsons Disease
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When To Be Concerned About Hand Tremors
Someone with a severe tremor can have their hands shaking uncontrollably. Fact is, everybody has the potential to experience tremors in some form. Dr. Tom Miller talks with movement disorder specialist Dr. Lauren Schrock about the two main types of tremors and how to identify the differences between them, possible causes, and when to be concerned.
May 20, 2014
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What Therapies Treat Shaky Hands
Your doctor may recommend one or more lifestyle changes as a way to possibly help ease the symptoms of essential tremor. Suggestions may include to:
- Use heavier objects. You may need to replace lightweight or delicate objects, such as glasses, silverware, or plates, with heavier versions. The extra weight may make the item easier to handle.
- Use specially designed utensils and tools. Gripping and controlling pens, pencils, garden tools, and kitchen utensils may be difficult if you have shaky hands. You may need to seek out versions of these items that are designed for individuals with grip and control issues. For example, there are many adaptive utensil options available on .
- Wear wrist weights. The extra weight on your arm may make control easier. Find a great selection of wrist weights here.
Clinical Examinations And Diagnostic Tests
Physicians evaluate tremors with clinical examination and diagnostic tests. Some of these tests are as follows:
Some tests, such as surface electromyograms and mechanical recording devices, help to define the rhythmicity, amplitude, and frequency of the tremors as well as the relationship between tremors and movements. These are not highly used in medical practice.
Other tests are useful to diagnose diseases that might be associated with the tremors.
In many instances a clinical examination might be more than enough to establish the diagnosis, and other tests are not indicated.
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Confusion With Essential Tremor
The tremor of Parkinsons disease is often confused with the tremor of a condition called Essential Tremor, or Benign Familial Tremor . Katherine Hepburn had Essential Tremor, and was originally misdiagnosed with Parkinsons. Ronald Reagan also had Essential Tremor. Both had a head tremor and a vocal tremor. In Essential Tremor, the hands are most commonly involved, followed by the head and then the voice. Essential Tremor can also cause the jaw to tremor, and it may be difficult to figure out if a jaw tremor is from Essential Tremor or Parkinsons. Unfortunately, some people may have both disorders. Some authorities believe that there is, in fact, an increased association between the two conditions, so that more people with Parkinsons disease have Essential Tremor than would be expected by chance alone, but this has not been established.
Cause Of Essential Tremor
Essential tremor is the most common type of tremor, and affects more people than Parkinsons disease. Some estimates suggest that around 1 in 5 people over the age of 65 years is affected.
There is no known cause, but a genetic link is strongly suspected. Each child of a person with essential tremor has a 50% chance of inheriting the disorder themselves. If a person with essential tremor has other affected family members, then the disorder is called familial tremor.
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Hand Tremors: What Are They
Hand tremors, or shaky hands, may not be life-threatening on their own, but they can still disrupt your life. In some cases, hand tremor may be a signal of neurological issues or degenerative disease. Its a good idea to seek out your healthcare provider if youve suddenly developed or noticed hand tremor.
Although learning more about your health and body on your own is important, an official diagnosis and treatment plan made in conjunction with your doctor is the best course of action to treat hand tremor symptoms.
When Should Someone See A Doctor For Shaky Hands
If you have hand tremors, seeking professional help sooner than later could prevent the worsening of a severe medical condition. Medications that slow the onset and progression of neurological disorders could be an essential step to managing your wellness. On the other hand, your healthcare professional may inform you that you just need to reduce stress in your life or switch to decaf. Either way, finding out why you have hand tremors should be a priority.;
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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.”
Cerebellar And Rubral Tremors
The classic cerebellar tremor is an intention tremor meaning that it is most prominent during an act of coordination such as pushing a button. The tremor will be worst as the finger is just about to meet its target. As the name suggests, cerebellar tremor is caused by damage to the cerebellum or its pathways in the brainstem.
Rubral tremor is a less common subtype of cerebellar tremor. It is slow, large in amplitude, and can occur in all directions. Unfortunately, there are no easy treatments for cerebellar tremor. If possible, the underlying cause should be addressed.
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How Are Parkinsons Tremors Treated
Tremor can be unpredictable. Some experts say its the toughest symptom to treat with medication. Your doctor may prescribe medication for your tremors:
- Levodopa/carbidopa combination medicines . This treatment is a type of medication called a dopamine agonist. Its usually the first treatment for Parkinsons.
What Is Essential Tremor
Essential tremor is a neurological disorder that causes your hands, head, trunk, voice or legs to shake rhythmically. It is often confused with Parkinson’s disease.
Essential tremor is the most common trembling disorder. Everyone has at least a small degree of tremor, but the movements usually cannot be seen or felt because the tremor is so small. When tremors are noticeable, the condition is classified as essential tremor.
Essential tremor is most common among people older than 65, but it can affect people at any age. Some experts have proposed considering ET that starts earlier in life as essential tremor and ET that begins later in life as age-related tremor, because the conditions may have different symptoms and may respond differently to treatments.
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How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
Symptoms Of Hand Tremors
Hand tremors can happen on and off or be constant. Some tremors may occur on their own without associated health problems, but other kinds of tremor may suggest a specific health issue like liver failure or MS.
Symptoms of hand tremor can include the following:
- Involuntary, rhythmic shaking in the hands and arms
- Difficulty writing or drawing
- Issues holding or controlling utensils or cups
- Trembling in one or both hands
- Shaking may worsen with movement
- Tremors may progress over time
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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.
Hand Tremors: How To Stop Shaky Hands
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Tremors are involuntary muscle spasms that can occur in many areas of the body. While twitching muscles can affect the eyes, legs, face, vocal cords, and other body parts, tremors are often associated with the hands. Living with hand tremors can be frustrating and make daily activities such as eating or dressing oneself difficult. Approximately 10 million people in the United States experience some form of hand tremors.;
There are numerous types of tremors and reasons why they happen. Some are temporary and go away on their own, and others are linked to more severe health problems. Learn more about what causes hand tremors, how to stop shaky hands, and when to seek medical advice from a healthcare professional about hand tremors.;
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Overview Of The Types Of Tremors
In order to determine the cause of a tremor, and hence, the best treatment options, it’s essential to know the type of tremor you have. Let’s take a look at how tremors are classified into different categories, as well as some of the terminology which is used to describe the characteristics of different tremors.
Behavior And Lifestyle Changes
Essential tremor can be affected by emotional stress, nicotine, and caffeine. Limiting stimulants and keeping your stress level down by practicing self-care and prioritizing your mental health can help reduce symptoms of ET.
Here are some other lifestyle changes you can make at home according to Hopkinsmedicine.org:
- Use heavier, sturdier utensils with larger handles for easier gripping
- Invest in clothing with Velcro or button hooks
- Use straws for drinking
- Consider wearing slip-on shoes
- Complete more difficult tasks when your tremors are less noticeable
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Talk To Your Doctor About Treatments
If youve experienced shaky hands or symptoms of essential tremor, make an appointment to speak with your doctor. Your doctor will likely request several medical and physical tests to rule out other possibilities before a diagnosis can be made.
Once a diagnosis has been made, you can begin to discuss treatment options. Treatment may not be necessary if the tremor is mild and doesnt interfere with day-to-day activities.
If the shaking becomes too difficult to manage, you can revisit the treatment options. Finding one that works well with minimal side effects may take time. Work with your doctor and any therapists or specialists you visit to find a plan that best suits your needs.
How Are Tremors Diagnosed
Sometimes, tremors are considered normal. When youre under a lot of stress or experiencing anxiety or fear, tremors may occur. Once the feeling subsides, the tremor usually stops. Tremors are also often part of medical disorders that affect the brain, nervous system, or muscles.
You should see your doctor if you develop unexplained tremors.
During a physical examination, your doctor will observe the affected area. Tremors are apparent upon visual inspection. However, the cause of the tremor cant be diagnosed until your doctor performs further tests.
Your doctor may request that you write or hold an object to evaluate the severity of your tremor. Your doctor may also collect blood and urine samples to check for signs of thyroid disease or other medical conditions.
The doctor may order a neurological exam. This exam will check the functioning of your nervous system. It will measure your:
- tendon reflexes
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Characteristics Of Pd Tremors
The tremors of PD characteristically occur at rest, stop with voluntary action, and recur again after you hold your new position for a few minutes. PD tremors can affect the hands, arms, face, jaw, legs, and/or feet, and are often slightly more prominent on one side than the other.
The tremor almost always begins in the hand before affecting other parts of the body, and it usually looks like you are rolling a pill between your thumb and index finger. Thats why its called a pill-rolling tremor.
A pill-rolling tremor is the most common type of PD tremor, but shaking tremorswhich may involve the hands or other areas of the bodycan also occur.
Which Body Parts Do Parkinsons Tremors Affect
There are five main places youll have Parkinsons tremors:
1. Hands. Parkinsons disease tremors often start in the fingers or hands with whats called a pill-rolling motion. Imagine holding a pill between your thumb and index finger and rolling it back and forth.
2. Foot. A Parkinsons foot tremor is more likely to happen while youre 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 youre standing may be another condition.
3. Jaw. This is common in people with Parkinsons. It may look like youre 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. Its rare, but a tongue tremor can cause your entire head to shake.
5. Internal. Some people with Parkinsons say they can feel a shaking sensation in their chest or abdomen. But cant be seen from the outside.
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What Is The Prognosis
Tremor is not considered a life-threating condition. ;Although many cases of tremor are mild, tremor can be very disabling for other people. ;It can be difficult for individuals with tremor to perform normal daily activities such as working, bathing, dressing, and eating. ;Tremor can also cause social disability.;; People may limit their physical activity, travel, and social engagements to avoid embarrassment or other consequences.;;
The symptoms of essential tremor usually worsen with age. ;Additionally, there is some evidence that people with essential tremor are more likely than average to develop other neurodegenerative conditions such as Parkinsons disease or Alzheimers disease, especially in individuals whose tremor first appears after age 65.
Unlike essential tremor, the symptoms of physiologic and drug-induced tremor do not generally worsen over time and can often be improved or eliminated once the underlying causes are treated.
Dementia With Lewy Bodies
- Dementia with Lewy bodies is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein;build up in multiple areas of the brain.
- DLB first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
- While the same abnormal protein is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of their disease.
- There are no specific treatments for DLB. Treatment focuses on symptoms.
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The Role Of The Cerebellum In Essential Tremor
Certainly, many studies have suggested that the cerebellum does not function normally in essential tremor. This may explain why some people with essential tremor have other cerebellar findings on their neurological examination, such as ataxia or poor hand-eye coordination.??
In the last decade, we have become increasingly aware that the cerebellum does more than coordinate movement it may help to coordinate thoughts and perhaps emotions as well. Studies have connected cerebellar activity with the dorsolateral prefrontal cortex, a region of the brain classically associated with problem-solving, attention, and memory.??