Dr Sarah Jarvis
Are tremors serious?
When patients come to see me with tremor, their first concern is always Parkinson’s disease. But fever, anxiety and stress are also common causes. Far less well known is essential tremor, which could affect eight times more people than those with Parkinson’s. How do you know what’s causingg youry tremor?
Overactive thyroid can lead to tremor, but it’s rarely the only symptom. Others include diarrhoea, heat intolerance, palpitations, anxiety and unexplained weight loss.
Anxiety can also cause tremor as part of the “fight or flight” response of adrenaline. Also, palpitations, shortness of breath, dry mouth and feeling anxious or panicky.
Parkinson’s is down to o shortage of dopamine, d which is used u to transmit messages m between brain b cells and nerves.
There are three main m sets of symptoms in n Parkinson’s: muscle stiffness, slowness of movement, and tremor. Not everyone develops all of them.
This can result in a slow, shuffling gait, problems getting up and stopping or turning once you’ve started walking, lack of expression in your face and speech, not swinging your arms when you walk, problems with fine muscle movements needed for dressing or writing, or poor balance and falls.
The tremor in Parkinson’s is seen especially in hands and arms, more noticeable when sitting still. It’s sometimes called a “pill rolling tremor”, as if you’re rolling a small object between your fingers.
Essential tremor (ET) is much less well known than Parkinson’s disease, even though it’s thought to affect up to a million people in the UK. This includes Julian Fellowes, creator of DowntonAbbey. He talked about his condition publicly after being accused of being drunk on stage. It often, but not always, runs in families and affects mostly over 40s, though it can start at any age.
Unlike Parkinson’s, tremor is the only major symptom in ET – but don’t underestimate its impact. It may come and go at first and tends to start in one arm or hand. Within a year or two it typically spreads to the other arm, and legs can be affected too. Up to 1 in 3 people also have head tremor, which can affect their speech.
Essential tremor isn’t usually noticeable at rest but starts as soon as you move. This can make everyday tasks like dressing, eating and
CAFFEINE IS A STIMULANT, OFTEN USEFUL TO PERK YOU UP, BUT TOO MUCH TREMBLY’’ CAN LEAVE YOU JITTERY AND
drinking, writing, even putting a key in a door, really challenging. Tiredness, stress, extreme temperature and high emotions like anxiety can make it worse. Many people with ET are understandably anxious about their tremor in public, so it can lead to a vicious cycle. People with ET often can’t hold down a job and retreat into their own homes to avoid stares.
Alcohol may relieve symptoms, but there’s a real risk of them turning to it too often. Some medications can help, but patients often stop because of side effects like dizziness and feeling sick.
Since tremor is a symptom rather than an illness, treatment is usually aimed at the cause. For instance, medication can correct an overactive thyroid or replenish supplies of the brain chemical shortage in Parkinson’s.
In the last few years, an option called deep brain stimulation has brought new hope to some people with severe Parkinson’s and ET. It involves implanting electrodes deep within your brain. These produce impulses to damp down abnormal activity leading to tremor.
Even more recently, a newer alternative called MR guided Focused Ultrasound has been developed for ET. Unlike deep brain stimulation, there’s no invasive brain surgery involved. Instead, high energy ultrasound waves are focused on the area deep inside the brain. They’re used to destroy the tiny area of brain responsible for the tremor. Results are immediate and it’s a huge advance.
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