Tremor, that's me.

Hi and assalammualaikum.Today I will about Tremor. Let's focused it. 

“What is tremor?

Tremor is an unintentional, rhythmic muscle movement involving to-and-fro movements (oscillations) of one or more parts of the body. It is the most common of all involuntary movements and can affect the hands, arms, head, face, voice, trunk, and legs. Mosttremors occur in the hands. In some people, tremor is a symptom of a neurological disorder or appears as a side effect of certain drugs. The most common form of tremor, however, occurs in otherwise largely healthy people. Although tremor is not life-threatening, it can be embarrassing to some people and make it harder to perform daily tasks”.

“What causes tremor?

Tremor is generally caused by problems in parts of the brain that control muscles throughout the body or in particular areas, such as the hands. Neurological disorders or conditions that can produce tremor include multiple sclerosis, stroke, traumatic brain injury, and neurodegenerative diseases that damage or destroy parts of the brainstem or thecerebellum. Other causes include the use of some drugs (such as amphetamines, corticosteroids, and drugs used for certain psychiatric disorders), alcohol abuse or withdrawal, mercury poisoning, overactivethyroid, or liver failure. Some forms of tremor are inherited and run in families, while others have no known cause”.

“What are the characteristics of tremor?

Characteristics may include a rhythmic shaking in the hands, arms, head, legs, or trunk; shaky voice; difficulty writing or drawing; or problems holding and controlling utensils, such as a fork. Some tremors may be triggered by or become exaggerated during times of stress or strong emotion, when the individual is physically exhausted, or during certain postures or movements.

Tremor may occur at any age but is most common in middle-aged and older persons. It may be occasional, temporary, or occur intermittently. Tremor affects men and women equally.

A useful way to understand and describe tremors is to define them according to the following types. Resting tremor occurs when the muscle is relaxed, such as when the hands are lying on the lap or hanging next to the trunk while standing or walking. It may be seen as a shaking of the limb, even when the person is at rest. Often, the tremor affects only the hand or fingers. This type of tremor is often seen in patients with Parkinson's disease. An action tremor occurs during any type of movement of an affected body part. There are several subclassifications of action tremor. Postural tremor occurs when the person maintains a position against gravity, such as holding the arms outstretched. Kinetic tremor appears during movement of a body part, such as moving the wrists up and down, while intention tremor is present during a purposeful movement toward a target, such as touching a finger to one's nose during a medical exam. Task-specific tremor appears when performing highly skilled, goal-oriented tasks such as handwriting or speaking. Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement”. 

“What are the different categories of tremor?

Tremor is most commonly classified by its appearance 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 forms of abnormal tremor. Although the tremor may be mild and non progressive in some people over a long period of time, in others, the tremor is slowly progressive, starting on one side of the body but affecting both sides within a few years. The hands are most often affected but the head, voice, tongue, legs, and trunk may also be involved, typically to a lesser extend than the hands. Tremor of the hands is typically present as an action tremor. 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. A variant in the gene LINGO1 has been identified as a risk gene, although not all individuals with essential tremor carry this variant--which also can be present in people without essential tremor. While essential tremor was thought not to be associated with any known pathology over many years, recent studies suggest that there is a mild degeneration of certain parts of the cerebellum in individuals with essential tremor.

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”.

“How is tremor diagnosed?

During a physical exam a doctor can determine whether the tremor occurs primarily during action or at rest. The doctor will also check for tremor symmetry, any sensory loss, weakness or muscle atrophy, or decreased reflexes. A detailed family history may indicate if the tremor is inherited. Blood or urine tests can detect thyroid malfunction, other metabolic causes, and abnormal levels of certain chemicals that can cause tremor. These tests may also help to identify contributing causes, such as drug interaction, chronic alcoholism, or another condition or disease. Diagnostic imaging using computerized tomography or magnetic resonance imaging may help determine if the tremor is the result of a structural defect or degeneration of the brain.

The doctor will perform a neurological exam to assess nerve function and motor and sensory skills. The tests are designed to determine any functional limitations, such as difficulty with handwriting or the ability to hold a utensil or cup. The individual may be asked to place a finger on the tip of her or his nose, draw a spiral, or perform other tasks or exercises.

The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation”. 

Are there any treatments for tremor?

There is no cure for most tremors.The appropriate treatment depends on accurate diagnosis of the cause.

Some tremors respond to treatment of the underlying condition. For example, in some cases of psychogenic tremor, treating the patient's underlying psychological problem may cause the tremor to disappear.

Symptomatic drug therapy is available for several forms of tremor. Drug treatment for parkinsonian tremor involves levodopa and/or dopamine-like drugs such aspramipexole and ropinirole. Other drugs used to lessen parkinsonian tremor includeamantadine hydrochloride and anticholinergic drugs.

Essential tremor may be treated with propranolol or other beta blockers(such as nadolol) and primidone, an anticonvulsant drug.

Eliminating tremor "triggers" such as caffeine and other stimulants from the diet is often recommended.

Physical therapy may help to reduce tremor and improve coordination and muscle control for some individuals. A physical therapist will evaluate the individual for tremor positioning, muscle control, muscle strength, and functional skills. Teaching the person to brace the affected limb during the tremor or to hold an affected arm close to the body is sometimes useful in gaining motion control. Coordination and balancing exercises may help some people. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.

Surgical intervention such as thalamotomy and deep brain stimulation may ease certain tremors. These surgeries are usually performed only when the tremor is severe and cannot be controlled satisfactorily with drugs”.