What are the different kinds of tremors?

Key points:

• There are generally three kinds of tremors: intention, essential and Parkinsonian

• A diagnosis of Parkinson’s disease in a person under the age of 50 is considered early-onset, which is rather rare and makes up one in five cases

• One in 100 people over the age of 60 receives a diagnosis of Parkinson’s disease in Australia

This edition of Disability Support Guide aims to answer the question: “why did I just experience a tremor?”

There are a multitude of reasons why people may experience tremors, however, the three primary categories of tremors will be explored in this article, along with some of the lesser-known causes. This article may help to clarify whether you should seek medical attention, a routine check-up or a chill pill to treat any concerns you may have.

What are intention tremors?

As the label would suggest, ‘intention tremors’ occur when the subject attempts to move in a coordinated manner and begins to tremor as they approach a ‘target’ of their movement, with a tremor of approximately five hertz or less.

Eg. David lifted a slice of pizza up to his mouth, but his hand began to tremor as he took a bite.

Intention tremors are commonly associated with multiple sclerosis and present as a slower, wider form of tremor when compared to an essential tremor — commonly affecting the upper limbs or occasionally the hands. Causes of intention tremor may include:

• Alcohol dependency
• Alcohol withdrawal
• Too much caffeine or nicotine
• Fragile X syndrome
• Stroke
• Wilson’s disease
• Brain tumours
• Low blood sugar
• Hyperthyroidism
• Hypoparathyroidism
• Insulinoma
• Emotional distress
• Medication side effects — benzodiazepine, stimulants, lithium or neuroleptics

Intention tremor is not a disability or severe condition in and of itself and can be the result of everyday emotions or activities, which — when processed — will resolve the tremors. However, prolonged or recurring intention tremor may point to a root cause which is impacting the cerebellum or how the brain regulates movement.

What are essential tremors?

Essential tremor is classified as a movement disorder that leads to constant rhythmic shaking, likely caused by hereditary factors in addition to the above causes for an intention tremor. Those with an involuntary tremor may have inherited it from a parent due to the estimated 50 percent likelihood that a parent will pass it on to their child.

Whereas people with an intention tremor experience slow and often zig-zagging movements, those with an essential tremor are likely to experience involuntary movements akin to vibration, leading to issues with handwriting, holding utensils and drinking from a cup.

Unlike intention tremors which can be cured through relatively innocuous means such as wrist weights, lifestyle modifications or physical therapy along with relaxation, essential tremor treatments — which, keep in mind, are largely hereditary — may require extensive measures.

Treatment for essential tremor may include:

• Tranquillisers
• Beta-blockers
• Anti-seizure medicine
• Botox injections
• Surgeries such as:
  • Thalamotomy
  • Deep Brain Stimulation
  • Gamma Knife Surgery
  • Ultrasound treatments

What are Parkinsonian tremors?

Parkinson’s disease affects movement and is a progressive neurodegenerative disorder, which means that — not only will it be lifelong and without a cure — it will continue to get worse throughout the life of someone with it. This means a person with the condition may be unable to work, drive, prepare food or perform many of the tasks which they could previously excel at.

If you or someone you know is caring for someone living with Parkinson’s disease, it is important that you understand the frustrations and prognosis of someone with this condition and try to be patient, as you assist them.

Along with studies that highlight the need for sustained and consistent exercise/movement to assist people with balance, studies also suggest that regular exercise and movement can ultimately stave off the progression of symptoms.

Medications for treating Parkinson’s disease act to either mimic dopamine, through dopamine agonists or promote concentrations of dopamine in the brain. Certain selective serotonin reuptake inhibitors, commonly known as SSRIs, such as fluoxetine have been shown to impact both serotonin and dopamine activity.

Similarly, deep brain stimulation or ‘DBS’ is common practice for treating abnormal movement associated with Parkinson’s disease, for people resistant to medication, through a form of intervention like a pacemaker. Instead, electrodes are inserted into the brain and connected to a device placed under the chest, with electric triggers corresponding to movement.

Support options for Parkinson’s disease include:

• Realisation Healthcare
• Parkinson’s Nurse Specialists
• Parkinson’s Western Australia
• Senior Helpers Southeast Melbourne
• Revolv Health

Have you struggled with tremors? Let the team at Talking Disability know your story, because we’d love to hear more from our audience!