If your hands shake on a regular basis, you’re not alone.
The condition is referred to by doctors as tremor and it’s often nothing to worry about.
“Tremor is the most common movement disorder … and it’s actually one of the most common neurological problems,” said Dr. Alfonso Fasano, co-director of the surgical program for movement disorders at Toronto Western Hospital.
“People get concerned because public opinion believes that … tremor is Parkinson’s disease, but most of the time, it’s not.”
There are many types of tremor, and in most instances, doctor intervention isn’t even necessary.
Here, Fasano explains the different kinds of tremor and when you should see a doctor.
Types of tremor
Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body, according to the National Institute of Neurological Disorders and Stroke.
The most common form is called physiological tremor, said Fasano.
“This tremor becomes more visible if it’s too cold or you’re stressed or you took too much coffee, for instance,” he said.
“Usually people don’t seek medical attention for that because they recognize that it’s going to go away.”
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It’s also normal if your body starts to shake after carrying something heavy for a long time, for example.
There’s another form of tremor that often worries people, and it’s known as action tremor.
“These are tremors that manifest during the execution of certain actions,” Fasano said. “I’m trying to drink a cup of tea and the tremor comes, for example.”
The other common form of tremor is called rest tremor, which is tremor manifesting “when the patient is doing nothing,” he said.
“You’re watching TV and your hand shakes,” said Fasano. “Actually, in this particular type of tremor, it’s often when the patient tries to do something … that the shaking stops.”
In some situations, one individual can experience both rest and action tremors.
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Most tremor patients have action tremor that is symmetrical, or it affects both hands the same way.
“It can actually affect other parts of the body too, like the vocal chords, the voice or the head, and usually these tremors aren’t caused by Parkinson’s disease,” said Fasano.
These are often diagnosed as essential tremor — “a very common diagnosis in neurology,” said Fasano — and these patients typically manifest tremor, but no other symptoms. They also often have a family history of tremor.
For most patients with essential tremor, the condition doesn’t become bothersome for several years.
“It may take even 40, 50 years,” said Fasano. “These patients know they have a little bit of tremor, but overall, they compensate.”
When to seek treatment really depends on the person. For professional dentists or surgeons, a small tremor can have a large impact. However, it’s usually when tremor becomes so severe it makes everyday tasks difficult or impossible that patients seek medical advice.
“For some people who have had the tremor 50 years at this point, you’re dealing with a 70-year-old patient with issues drinking from a cup or buttoning a shirt,” he said.
“Some people actually lose weight because they can’t feed themselves properly or they don’t want to eat in public at restaurants.”
At this point, some people may seek treatment, of which there are several options.
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“First, we recommend some tests … to rule out associated syndromes,” said Fasano.
“For instance, if you have a thyroid issue or you’re [ingesting] too much thyroid hormone [as treatment for another condition] … you can actually manifest a tremor.”
This could also happen in people with diabetes who use too much insulin.
The next step is to discuss potential therapy, Fasano said.
“There are some medications, but they may not help everyone,” he said. “Some people use medication only when needed … for example, a surgeon right before an operation.”
These can include beta-blocking drugs, anti-seizure medications, tranquilizers, Parkinson’s disease medications and botulinum toxin injections, according to the National Institute of Neurological Disorders and Stroke.
Sometimes, the medication doesn’t work or the tremor is too severe. In this case, something called a focused ultrasound may be considered.
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Focused ultrasound uses magnetic resonance images to create a lesion in tiny areas of the brain’s thalamus, which is thought to be responsible for causing the tremors. At present, said Fasano, this relatively new treatment only helps for patients with essential tremor.
In the event that these interventions don’t help, surgery may also be an option. There are two main types of surgery: deep brain stimulation (DBS) and thalamotomy.
DBS — also known as a “pacemaker for the brain,” Fasano explained — uses surgically-implanted electrodes to send high-frequency electrical signals to the thalamus. A small pulse generating device placed under the skin in the upper chest sends electrical stimuli to the brain and temporarily disables the tremor.
“Through electricity, we can control the activity of those neurons and therefore reduce the tremor,” he said.
However, some people are unable to undergo surgery or they don’t want to have something permanently placed in their body.
In this case, there are three other options which will also “destroy the neurons causing the tremors,” said Fasano.
- Your surgeon can insert a “piece of an electrode” in the brain to burn the neurons. “It’s invasive, but you remove everything,” he said.
- Gamma knife radiotherapy uses radiation to shoot and kill the neurons. This is minimally invasive.
- The newest option is called MRI-guided focused ultrasound, “which shoots over 1,000 ultrasound beams from the outside … and they all converge in the spot on the brain that we want to kill,” said Fasano. This option is also minimally invasive and can be done in three to four hours.
Parkinson’s disease is the second most common neuro-degenerative disorder in Canada, after Alzheimer’s disease.
According to Statistics Canada, the condition results from the loss of cells in the brain that produce dopamine, a chemical that controls the body’s movements.
Rest tremor is a typical symptom of Parkinson’s disease. It’s often unilateral (on one side) or asymmetrical (one side worse than the other), said Fasano. However, it’s usually accompanied by slower and more rigid muscle movement, impaired reflexes and poor balance.
Other symptoms can include depression, anxiety, emotional changes, cognitive impairment, difficulty swallowing, chewing and speaking, masked facial expressions, urinary problems, constipation, fatigue, and sleep problems.
It’s important to note that symptoms typically vary broadly from one person to the next.
“Not all Parkinson’s patients shake,” said Fasano. “There’s a third of Parkinson’s patients without tremor.”
— With files from Global News’ Dani-Elle Dubé
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