21st June 2023

Tremors

A tremor is an involuntary, rhythmic muscular contraction causing shaking.

Essential Tremors

Essential tremors (ETs) are highly familial. Most patients present with hand and arm tremors and head tremors. ETs are at 4-10Hz. It occurs in certain postures or during movement. It is exacerbated by heightened emotion, stress, fever, and hypoglycaemia. Most essential tremors improve with alcohol or β-blockers.

The treatments for ETs are:

• β-blockers
• Antidepressants
• Anti-epileptic drugs (AEDs)
• Benzodiazepines
• Botulinum toxin

Resting Tremors

Resting tremors (RT) occur when the muscles are relaxed. It is classically a 3-5Hz pill-rolling of the hands or fingers. RT is seen in Parkinson’s Disease (PD) and parkinsonism. The features and treatment of PD and Parkinsonism are discussed in greater detail later.

Intention Tremors

Intention tremors occur when doing a purposeful movement or task. They get worse as they get closer to their target. It usually affects the upper limbs. The tremors are slow and high amplitude. It is caused by pathology affecting the cerebellum, such as stroke, multiple sclerosis, or neurodevelopmental disorders. Treatment depends on the cause.