Tremors: Classification and Treatment

This is an automatically translated article.

The article was consulted with Dr. Phan Dinh Thuy Tien - General Internal Medicine - Department of Medical Examination & Internal Medicine - Vinmec Nha Trang International General Hospital.
Tremor is a fairly common movement disorder in which the patient is unable to control his or her actions and limits his movements. Classification of tremors into groups is essential to select the appropriate treatment for the patient.

1. What is tremor?

Tremor is a condition of muscle contractions that are continuous, frequent, and out of control. This condition can occur alone on certain parts of the body such as arms, legs, eyes, jaw or as large as one side of the body.
Tremor is one of the most common movement disorders, especially in middle-aged and elderly people, although it can still occur at any age, gender is the same. Moreover, although it often occurs alone, without any other symptoms, it is not dangerous, but tremor has a great impact on quality of life, limiting the patient's ability to integrate in life. community life.
Therefore, the treatment of tremor thoroughly has a very important meaning for the patient's life. However, there are many possible causes of tremors. Therefore, a clear classification of tremor will guide effective and safe treatment for patients.

2. How to classify tremor?

Tremors are classified in a variety of ways, but the most common is the classification according to its occurrence and cause or origin. The following are common types of tremors, including:

2.1 Essential tremor

Essential tremor, formerly known as benign essential tremor or familial tremor, is one of the most common movement disorders. The exact cause of essential tremor is still not well understood.
For some people, this tremor is usually mild and stays stable for many years. Manifestations of essential tremor usually appear on both sides of the body but are more often noticed in the hands because this is an action tremor, which occurs only when the patient works, decreases, and stops. when resting. Other symptoms may include shaking of the head such as the person nodding or shaking the head repeatedly, shaking when speaking if the tremor affects the vocal cords.
The frequency of tremors may decrease as the person gets older, but the severity can increase, affecting the ability to perform daily activities. In addition, factors such as emotions, stress, fever, exhaustion, and hypoglycemia can make tremors more pronounced.

2.2 Tremor due to dystonia

Dystonic tremor is a manifestation of movement disorders caused by incorrect messages from the brain causing the muscles to overwork, resulting in abnormal posture or unwanted movements. This phenomenon tends to appear in young or middle-aged people rather than the elderly and can affect any muscle in the body. Symptoms can sometimes be relieved by relaxation, complete rest.
In addition, the severity of dystonia tremor lies in the fact that the tremor can also be triggered by touching a vulnerable part of the body or muscle. At this point, the muscles will vibrate, shaking at an irregular frequency and amplitude instead of rhythm like essential tremor.

2.3 Cerebellar tremor

Cerebellar tremor is usually slow, high amplitude movements that are easily seen in the extremities, such as arms and legs. The time when the tremor is most noticeable is when the person is trying to complete the action, unlike other tremors that occur when the action is initiated.
The cause of cerebellar tremor is thought to be damage to the cerebellum or to the pathways that connect the cerebellum in the function of motor control to other brain regions that control action. The most common injury is caused by a stroke or ischemic stroke. In addition, cerebellar tremor can also be caused in diseases such as multiple sclerosis, hereditary degenerative disorders such as ataxia, and chronic cerebellar damage due to alcohol abuse.

2.4 Psychotic tremor

Psychogenic tremor, also called functional tremor, can present in any form of tremor. The appearance of tremors can vary but often begins suddenly and can affect all parts of the body. The circumstances in which psychomotor tremors are triggered and stimulated are when the patient is stressed, the tremor is accompanied by palpitations, and it decreases or disappears when distracted. Some people develop psychomotor tremors because of an underlying psychiatric condition such as depression or post-traumatic stress disorder.

2.5. Physiological tremor

Physiological tremor is a tremor that occurs in anyone, all healthy individuals. Sometimes not visible to the naked eye, the patient still feels the appearance of shaking on the arms, legs, trunk, jaw area.
This is not a disease at all, but a normal human phenomenon, responding to physical changes in the body such as cold, high fever, intense activity.
In addition, when physiological tremor presents with a higher degree, it will be classified as enhanced physiological tremor. In which, the manifestation of physiological tremor can now be easily seen. The cause of increased physiological tremor is usually not a neurological disease but a reaction to certain medications, alcohol withdrawal, or other medical conditions such as hyperthyroidism or hypoglycemia. Fortunately, increased physiological tremor can radically improve when the cause is corrected.

2.6 Parkinson's tremor

Parkinson's tremor is a common symptom of Parkinson's disease, although not all people with Parkinson's disease experience tremors. In general, the symptoms of Parkinson's tremor are tremors in one or both hands at rest. Other sites that can also be affected are the chin, lips, face, and legs.
Symptoms of Parkinson's tremor may initially appear on only one limb or only on one side of the body. As the disease progresses, the condition can spread to both sides of the body and become worse when the person is stressed or emotionally strong.

2.7 Concussion tremors

Concussion tremor is a rare movement disorder characterized by rapid muscle contractions in the legs that occur while standing. Patients with concussion tremor often have a feeling of unsteadiness or loss of balance, prompting them to immediately try to sit up or walk instead of sitting still.
Because concussion tremors are often high-frequency and may not be visible to the naked eye, physical examination can still be felt by palpating the thigh or calf or examining the muscles with a stethoscope. In some cases, tremors can become more severe over time while the cause of tremors is unknown.

3. How to treat tremors?

Although there is no cure for most forms of tremor, current treatment options can help manage symptoms. In some cases, the symptoms, if mild, do not cause much impact, do not need treatment.
However, before starting, it is necessary to determine the appropriate treatment as depends on the correct diagnosis of the cause. With tremors due to an underlying medical condition, sometimes the patient can be improved or completely eliminated with treatment of the underlying cause, for example, tremor due to hyperthyroidism will improve or even resolve completely when treated. treatment with antithyroid drugs. Also, if the tremor is caused by medication, stopping the medication that causes the tremor may reduce or eliminate the tremor.
If there is no underlying cause for the tremor, the available treatment options may also be helpful, such as beta-blockers, antiepileptic drugs, or tranquilizers that block nerve activity. However, it's important to note that some of these drugs can also cause tremors.

In addition, other treatment options may be considered if the tremor is not controlled, such as botulinum toxin injections, deep brain stimulation, or surgery.
In summary, tremor should never be considered a life-threatening condition. However, while some people experience only mild, transient tremors, others experience significant limitations in normal daily activities. By classifying the above common tremors and actively seeking and treating the cause of the tremor, patients will have hope for a greater improvement in their quality of life.
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