Causes of muscle tremors. Hand trembling: possible causes

Tremor is the process of involuntary shaking of the body or its individual parts. It is regulated by nerve impulses and the contractility of muscle fibers. Most often, tremor is a symptom of damage to the nervous system, but it can also be episodic, occurring after training or stress. Why does shaking occur, can it be controlled and when should you see a doctor?

General characteristics of the condition

Tremor is an involuntary rhythmic contraction of muscles that a person cannot control. The process involves one or more parts of the body (most often it occurs in the limbs, less often in the head, vocal cords, and torso). Patients in the older age category are most susceptible to chaotic muscle contractions. This is due to a weakening of the protective functions of the immune system and concomitant diseases. In general, tremor does not pose a serious threat to life, but it does significantly reduce the quality of life. The shaking can be so severe that it prevents a person from lifting small objects or sleeping peacefully.

Possible reasons for development

In most cases, trembling is caused by injury or pathological processes in the deep parts of the brain responsible for movement. Involuntary contractions can be a symptom of multiple sclerosis, stroke, and neurodegenerative diseases (for example, Parkinson's disease). They may also indicate kidney/liver failure or a malfunction of the thyroid gland. In medical practice, a predisposition to tremor due to genetic factors is often encountered.

Sometimes trembling does not indicate a disease, but is a protective reaction of the body to external stimuli. Among them are mercury poisoning, alcohol intoxication, and severe emotional stress. In this case, the tremor is short-term and disappears along with the stimulus.

Trembling never occurs for no reason. If you cannot explain the origin of the tremor or its intensity seems frightening, consult a doctor.

Classification of involuntary contractions

Doctors divide tremor into 4 categories - primary, secondary, psychogenic, and tremors due to diseases of the central nervous system. Primary tremor occurs as a natural protective reaction of the body to cold, fear, intoxication and does not require treatment. The remaining categories are manifestations of serious diseases that require medical attention.

Classification by mechanism of occurrence

Trembling can develop in only two cases - at a time of activity or relative muscle rest. Action tremor (action tremor) is triggered during voluntary contraction of muscle fibers. The signal that the nervous system sends to the muscle is connected to several additional impulses, which cause trembling. Action tremor can be postural, kinetic and intentional. Postural tremors occur when holding a pose, kinetic trembling occurs at the moment of movement, and intentional trembling occurs when approaching a goal (for example, when trying to take something, touch the face/other part of the body).

Rest tremor occurs only in a relaxed state and disappears or is partially dulled during movement. Most often, the symptom indicates progressive neurological diseases. As the disease progresses, the amplitude of oscillations slowly increases, which seriously impairs the quality of life and limits a person’s functionality.

Types of tremor

The main types of tremor include:

1. Physiological tremor. Most often it is localized in the hands and is practically not felt by a person. It is short-term in nature and occurs against a background of anxiety, fatigue, exposure to low temperatures, alcohol intoxication or chemical poisoning. Also, physiological tremors can be a side effect of the use of potent drugs.
2. Dystonic tremor. The condition is typical for patients with dystonia. In most cases, it occurs against the background of a dystonic posture and gradually intensifies as the disease develops.
3. Neuropathic tremor. Postural-kinetic tremors, most often caused by a genetic predisposition.
4. Essential tremor. In most cases, it is localized in the hands and is bilateral in nature. Muscle contractions can affect not only the arms, but also the torso, head, lips, legs and even vocal cords. Essential tremor is genetically transmitted. It is often accompanied by a mild degree of torticollis, muscle tone of the limbs and spasm during writing.
5. Iatrogenic or drug tremor. Occurs as a side effect from the use of medications or unqualified actions of a doctor.
6. Parkinsonian tremor. This is the so-called “resting tremor”, which weakens during movement or any other activity. The symptom is characteristic of Parkinson's disease, but can also occur in other diseases with Parkinson's syndrome (for example, multiple system atrophy). Most often it is localized in the arms, sometimes the legs, lips, chin are involved in the process, and less often the head.
7. Cerebellar tremor. This is an intention tremor, less often manifested as a postural tremor. The trembling process involves the torso, less often the head.
8. Holmes tremor (rubral). A combination of involuntary postural and kinetic contractions that occurs during rest.

Features of therapy

Muscle contractions do not always require treatment. Sometimes their manifestations are so insignificant that a person does not feel much discomfort and continues to function at his usual rhythm. In other cases, the search for suitable treatment directly depends on the diagnosis.

How is tremor diagnosed?

Diagnosis is based on studying the patient's medical history, physiological and neurological examination. At the stage of physiological examination, the doctor identifies the mechanism of development, localization and manifestations of tremor (amplitude, frequency). A neurological examination is necessary to obtain a complete picture of the disease. Perhaps involuntary trembling is associated with speech impairment, increased muscle stiffness, or other abnormalities.

After the initial examination, the doctor issues a referral for general blood and urine tests. This will help eliminate metabolic factors in the development of tremor (for example, malfunctions of the thyroid gland). Subsequent diagnostic procedures depend on the individual characteristics of the patient. For example, a specialist may prescribe an electromyogram (EMG). EMG is a method for studying muscle activity and muscle response to stimulation.

In case of brain injuries, a referral is given for a CT or MRI, and in case of severe tremors (the person cannot hold a pen/fork) - for a functional study. The patient is asked to perform a series of exercises, according to which the doctor assesses the condition of his muscles and the reaction of the nervous system to a particular task. The exercises are very simple - touch your fingertip to your nose, bend or raise a limb, etc.

Drug and surgical treatment

Essential tremor can be treated with beta blockers. The medication will not only normalize blood pressure, but also eliminate stress on the muscles. If your body refuses to respond to a beta blocker, your doctor may prescribe special anticonvulsant medications. For other types of tremor, when the main treatment has not yet worked, and you need to get rid of the tremors as soon as possible, tranquilizers are prescribed. They provide short-term results and can cause drowsiness, loss of coordination and a number of unwanted side effects. Moreover, regular use of tranquilizers can cause addiction. Botulinum toxin injections or high-intensity focused ultrasound can also be used for therapeutic purposes.

Do not self-medicate. Strictly follow your doctor’s recommendations, do not change the indicated dosages, so as not to worsen the situation.

If drug treatment is ineffective, doctors use surgical methods - deep brain stimulation or radiofrequency ablation. What it is? Deep brain stimulation is a surgical procedure in which a pulse device is inserted under the skin of the chest. It generates electrodes, sends them to the thalamus (the deep structure of the brain responsible for movement), thereby eliminating tremors. Radiofrequency ablation heats the thalamic nerve, which is responsible for involuntary muscle contractions. The nerve loses the ability to generate impulses for at least 6 months.

Medical prognosis

Tremor is not a life-threatening condition, but it can significantly affect quality of life. Daily routine activities, such as washing dishes, eating food, typing, are difficult or completely impossible. Additionally, tremor limits social and physical activity. A person refuses communication and usual busyness in order to avoid awkward situations, embarrassment, and other things.

The medical prognosis depends on the root cause of rhythmic contractions, their type and individual characteristics of the body. For example, manifestations of essential tremor may increase with age. Moreover, there is evidence that involuntary trembling is associated with an increased risk of developing other neurodegenerative conditions (for example, Alzheimer's disease). Physiological and drug tremor are easy to treat, so the prognosis for them is favorable, but eliminating hereditary factors is much more difficult. The main thing is to consult a doctor in a timely manner and start therapy.

Tremor is an involuntary vibration of any part of the body caused by alternating or synchronous contractions of reciprocally innervated muscles.

Diagnosis of the disease underlying tremor is often a very difficult task, the solution of which first of all requires a correct syndromic description of tremor. In connection with the above, great importance is attached to the principles of clinical description of tremor.

• The most important principle is a clear distinction between 3 types of tremor: resting tremor, postural tremor and intentional tremor. If in the same patient not only a rest tremor is detected, but also a postural or intention tremor, then all types of tremor are described and recorded as separate independent types, be sure to emphasize the relative severity of each of them. For example, a patient may have a rough resting tremor, a less pronounced postural tremor, and an even less pronounced intentional tremor. This picture is typical for severe trembling forms of parkinsonism. These same components of tremor outside the framework of parkinsonism usually have different relationships: either postural tremor predominates (which is typical for severe essential tremor) or intention tremor (with lesions of the cerebellum).
• Other important principles for describing tremor are:
  • Localization (arms, head, facial muscles, lower jaw, tongue, lips, cheeks, vocal cords, legs, torso), distribution features (hemitype, generalized, etc.), as well as other topographic features (for example, trembling of the thumb only or abdominal wall muscles, trembling of the eyeballs or orthostatic tremor, distal or proximal accentuation of tremors, symmetry/asymmetry).
  • Motor pattern of trembling (flexion-extension; pronation-supination; “pill-rolling”, “yes-yes”, “no-no” type; flapping).
  • Amplitude-frequency characteristics, severity of jitter, features of its course (variants of debut and subsequent dynamics).
  • The syndromic environment of tremor, that is, a description of those neurological symptoms against which the tremor manifests itself.

Compliance with the above principles for describing tremor syndrome is a necessary prerequisite for successful differential and nosological diagnosis of tremor.

What causes tremors?

• Resting tremor (3.5-6 Hz).
  • Parkinson's disease.
  • Secondary (symptomatic) parkinsonism.
  • “Parkinsonism plus” syndromes and other hereditary degenerative diseases accompanied by parkinsonism syndrome (Wilson-Konovalov disease, Hallerwarden-Spatz disease, and many others).
• Postural tremor (6-12 Hz).
  • Physiological tremor.
  • Increased (accentuated) physiological tremor (with stress, endocrine diseases, intoxication).
  • Benign essential tremor (4-12 Hz): autosomal dominant, sporadic, in combination with certain diseases of the central nervous system (Parkinson's disease, dystonia) and the peripheral nervous system (polyneuropathy, reflex sympathetic dystrophy).
  • For organic pathology of the brain (toxic, tumor and other lesions of the cerebellum, Wilson-Konovalov disease, neurosyphilis).
• Intention tremor (3-6 Hz) is caused by damage to the brainstem, cerebellum and their connections (multiple sclerosis, degeneration and atrophy in the brainstem and cerebellum, Wilson-Konovalov disease, vascular diseases, tumors, intoxication, head injury, etc.).
• Rubral tremor.
• Psychogenic tremor.

Neurochemical changes in tremor

A study of the brains of deceased patients with essential tremor did not reveal any specific pathomorphological changes or a specific neurochemical defect. Although lesions of cerebellar efferents or afferents can cause tremor, whether any specific neurochemical defect underlies it remains unclear. Neuroimaging studies help identify neural circuits involved in the pathogenesis of tremor.

Types of tremor

Rest tremor

Resting tremor usually has a frequency of 3.5-6 Hz. Low-frequency (most often 4-5 Hz) resting tremor is a typical manifestation of Parkinson's disease, as well as many other diseases of the nervous system accompanied by parkinsonism syndrome, which is why it is often called parkinsonian tremor. Secondary (symptomatic) parkinsonism (vascular, post-encephalitic, drug-induced, toxic, post-traumatic, etc.) also usually manifests itself as tremors (although it is less typical for vascular forms of parkinsonism), which has the same characteristics as in Parkinson's disease (low-frequency resting tremor with a characteristic distribution, course and tendency to generalization).

Postural tremor

Postural tremor appears in a limb when it is held in any position. This vibration has a frequency of 6-12 Hz. Postural tremor includes physiological tremor (asymptomatic tremors), enhanced (accentuated) physiological tremor that occurs during emotional stress or other “hyperadrenergic” conditions (thyrotoxicosis, pheochromocytoma, administration of caffeine, norepinephrine and other drugs), essential tremor, as well as tremor during some organic diseases of the brain (severe cerebellar lesions, Wilson-Konovalov disease, neurosyphilis).

Intention tremor

Intentional tremor has a characteristic motor pattern, its frequency is 3-5 Hz. Intention tremor is characteristic of damage to the brain stem, cerebellum and its connections (multiple sclerosis, degeneration and atrophy of the cerebellum and brain stem, Wilson-Konovalov disease, as well as vascular, tumor and toxic lesions of this area of ​​the brain). Their diagnosis is carried out by the characteristic concomitant neurological symptoms, indicating the involvement of gray and white matter in the brainstem and cerebellum, often with a typical picture on CT or MRI.

It should be remembered that the cerebellar variants of tremor include not only intention tremor, but also such phenomena as titubation, manifested by rhythmic oscillations of the head and sometimes torso (especially noticeable when the patient is standing), postural tremor of the proximal limbs (hips or chest).

Rubral tremor

Rubral tremor (more correctly called midbrain tremor) is characterized by a combination of resting tremor (3-5 Hz), even more pronounced postural tremor and the most pronounced intention tremor (intentional tremor → postural tremor → resting tremor). It appears when the midbrain is damaged due to a stroke, traumatic brain injury, or, less commonly, during a tumor or demyelinating (multiple sclerosis) process in the peduncles of the brain. This tremor appears in the limbs opposite the side of the midbrain lesion.

Psychogenic tremor

Psychogenic tremor is one of the variants of psychogenic movement disorders. Clinical criteria for psychogenic tremor include a sudden (usually emotional) onset, a static or wave-like (but not progressive) course, the presence of spontaneous remissions or remissions associated with psychotherapy, a “complex” nature of the tremor (all major types of tremor can be equally represented), the presence of clinical dissociations (selective preservation of some functions of the limb in the presence of gross tremors), the effectiveness of placebo, as well as some additional signs (including complaints, anamnesis and results of a neurological examination) confirming the psychogenic nature of the disorder.

Physiological tremor

Physiological tremor is present normally, but is manifested by such small movements that it becomes noticeable only under certain conditions. Usually this is a postural and intention tremor, low-amplitude and fast (8-13 per second), detected when stretching the arms. Physiological tremor increases in amplitude with anxiety, stress, fatigue, metabolic disorders (for example, hyperadrenergic states during alcohol, drug withdrawal or thyrotoxicosis), in response to a number of drugs (for example, caffeine, other phosphodiesterase inhibitors, beta-adrenergic agonists, glucocorticoids ). Alcohol and other sedatives usually suppress the tremor.

If there are no serious complaints, no treatment is required. Physiological tremor, which increases with alcohol withdrawal or thyrotoxicosis, responds to treatment for these conditions. Oral benzodiazepines 3-4 times daily (eg, diazepam 2-10 mg, lorazepam 1-2 mg, oxazepam 10-30 mg) help with tremors associated with chronic anxiety, but long-term use should be avoided. Propranolol 20–80 mg orally 4 times/day (as well as other beta blockers) is often effective for drug-induced tremors or acute anxiety (eg, stage fright). If beta blockers are ineffective or not tolerated, primidone 50-250 mg orally 3 times/day can be tried. Sometimes small doses of alcohol are effective.

Other types of tremors

The literature mentions as independent phenomena the so-called dystonic tremor (shaky spastic torticollis, quivering writer's cramp), "rabbit" syndrome (neuroleptic tremors of the lower jaw and lips). Phenomenologically, rhythmic phenomena such as asterixis (flapping, negative myoclonus), myorhythmia, and segmental myoclonus resemble tremor, but according to the mechanism of formation they do not belong to tremor.

Special forms of tremor (orthostatic tremor, “smile tremor”, voice tremor, chin tremor - geniospasm) are classified as variants of essential tremor.

The most common type of postural and kinetic tremor is enhanced physiological tremor, which usually has low amplitude and high frequency (12 cycles/s). Physiological tremor increases after physical activity, with thyrotoxicosis, and taking various medications, such as caffeine, adrenergic agonists, lithium, valproic acid.

Essential tremor

The next common type of tremor is the so-called essential or family tremor, which is usually slower than enhanced physiological tremor. Essential tremor can involve the extremities, as well as the head, tongue, lips, and vocal cords. Tremor increases with stress and in severe cases can lead to disability of the patient. Patients with this variant of tremor often have close relatives suffering from the same disease. However, the location and severity of tremor within a family varies significantly. The limbs may be involved asymmetrically, but strictly unilateral tremor usually indicates another disease. Tremors are often relieved by alcohol intake but are aggravated by caffeine, stress, or concomitant thyrotoxicosis (as is increased physiological tremor). In different limbs, the tremor is asynchronous - in contrast to the synchronous resting tremor in Parkinson's disease. In this regard, a patient who, due to tremor, is unable to hold a cup of liquid with one hand without spilling it, copes with this task much better by holding the cup with both hands - asynchronous movements of the hands partially dampen each other’s vibrations.

Benign essential tremor currently includes not only autosomal dominant and sporadic variants of essential tremor, but also its combination with other diseases of the central and peripheral nervous system, including dystonia, Parkinson's disease, peripheral neuropathies (CIDP, hereditary sensorimotor neuropathy I and types II, GBS, uremic, alcoholic and other polyneuropathies).

There are several options for diagnostic criteria for essential tremor, one of the most commonly used is given below.

Diagnostic criteria for essential tremor (Rautakoppi et al., 1984).

1. Frequently occurring (at least several times a week) or constant tremor of the limbs and/or head.
2. Postural or kinetic nature of the tremor (there may be no intentional component).
3. Absence of other neurological diseases that can cause tremor.
4. Absence of anamnestic indications for treatment with any drugs that can cause tremor.
5. Indications in the family history of similar tremor in other family members (confirm the diagnosis).

Tremor can occur with other extrapyramidal diseases, such as myoclonic dystonia, characterized by rapid muscle twitching. Orthostatic tremor and isolated postural tremor are distinguished as separate options. Currently, there is an active search for a genetic defect in essential tremor. To date, it has been possible to map the gene only in isolated familial cases, but its product has not yet been identified. It is possible that the disease is associated with multiple genes. Different families often differ in their reaction to alcohol and the presence of concomitant extrapyramidal syndromes (myoclonus, dystonia, parkinsonism). Once a genetic defect has been identified in different families, it will be possible to determine which clinical features are genetically determined and which simply reflect the phenotypic variability of the disease.

Cerebellar tremor

With lesions of the cerebellum, tremor usually also has a kinetic and postural nature. Low-frequency oscillations of the limb arise as a result of instability of its proximal part. At the same time, the tremor goes away if the limb is stabilized. Differentiation of cerebellar and essential types of tremor is usually not difficult. Cerebellar tremor intensifies as the limb approaches the target, while with essential tremor the amplitude of hyperkinesis remains approximately the same throughout the entire targeted movement. With lesions of the cerebellum, in addition to tremor, there is also a pronounced impairment of coordination of fine movements, while with essential tremor, coordination of movements usually does not suffer.

You, of course, met the expression "the hamstrings are shaking." Usually this is said about a very frightened person. In this case, the tendons and ligaments of the knee joints are called “hamstrings”. This apt definition is given by the people to the condition when the legs begin to tremble from fear or strong anger. But what if, even in the normal state, your arms and legs shake or something like a “chill” shakes your body? Urgently run to the doctor or try to change your lifestyle?

Thrill of passion or nervous trembling?

Ophelia:
- Good God!
I'm shaking with fear!

Polonium:
- From what?
The Lord is with you!

Ophelia:
- I was sewing. Hamlet enters
Without a hat, a sleeveless vest in half,
Stockings up to the heels, stained, without garters,
It shakes so much you can hear it knocking
Knee on knee, so confused,
As if I was in hell and came running
Talk about the horrors of Gehenna.

Polonium:
- Are you mad with passion?

Ophelia:
- I will not say,
But I'm afraid.

We live in a very difficult time, full of anxiety and stressful situations. Increasingly, when visiting a neurologist, patients complain that they cannot cope with their emotions, suffer from insomnia, irritability, fatigue and decreased performance. They even learned a new word: “I’m depressed, doctor.” More and more patients are complaining of hand tremors. People ask what can be done about it. And, of course, in each individual case the doctor’s answer will be different. Let's try to figure out the reasons together.

Tremor. Doctors use this short word to describe trembling in any part of the body (local tremor) or throughout the body (generalized). To quickly check whether your hands are shaking, just stretch them out in front of you, palms down, placing one sheet of paper on your hands; relax your fingers and tense them, and then drop your hands onto your knees and finally completely relax your fingers, as if you were grasping a ping-pong ball.

Believe me, a significant number of people do not pay attention to this, sometimes very dangerous symptom of severe neurological diseases! Therefore, as a doctor, I ask you to check your children and elderly parents, who for some reason try for a particularly long time to “not notice” the obvious.

Depending on the origin, there are two types of tremor: physiological and pathological.

Physiological tremor– occurs periodically in all people, most often manifests itself in the hands when stretched in front of oneself. Increased physiological tremor (“tremor of tired muscles”) appears after active loads on the muscles, with strong excitement, emotions - this is normal.

An overly emotional person may experience hand tremors almost constantly. However, as soon as the person calms down, the tremor noticeably decreases and sometimes disappears completely. But a new emotional experience again can lead to the appearance of trembling.

Sometimes depression or strong emotions can be manifested by such uncontrollable “chill-like” tremors of the whole body that the person literally “pounds”. But this condition passes. Therefore, a tremor that appears with severe fatigue, emotional overstrain or strong excitement, doctors advise not to treat, but only to observe.

Physiological tremor usually occurs in adolescence or adolescence. It usually starts with one hand, then spreads to the other. Tremors of the head, chin, tongue, and occasionally the torso and legs are possible. At the same time, a person can write with a pen, hold a cup, spoon and other objects.

The tremor increases with excitement and alcohol consumption. If the muscles of the tongue and larynx are involved in the process, speech is disturbed. The gait does not change. Treatment for this type of tremor is not required in most cases.

Sometimes physiological tremors include trembling with hypothermia and fever, coffee and energy abuse, a single intake of psychoactive substances (for example, sleeping pills, sedatives, or use of an inhaler for the treatment of bronchial asthma), hypoglycemia (including with an overdose of hypoglycemic drugs or fasting, prolonged strict diet combined with physical exertion), as well as twitching of the eyelids or muscles of half of the face (hemifacial spasm). However, in different classifications this type of jitter is treated differently.

One condition unites all these conditions: when the provoking factor disappears, the tremor disappears. For example, a physiological tremor includes trembling of the limbs with a single intake of alcohol, although more often, having “taken a little on the chest”, a person is surprised to find that the “shaking” is over. Alas, alcohol does not cure tremors, and its regular use only provokes a repeated attack of “shaking”.

It should be remembered that although physiological tremor is a rather harmless condition, in some people it can develop into a serious and dangerous form.

Pathological tremor- appears with various diseases and painful conditions:

• Atherosclerosis of cerebral vessels (narrowing of arterial vessels due to the deposition of cholesterol plaques in their membranes) with the development of chronic cerebrovascular accident.
• Parkinson's disease is a disease characterized by the development of progressive muscle stiffness and small-scale resting tremors. According to statistics, this disease usually develops in people over fifty-seven years of age, but in our troubled times the disease has become noticeably “younger.”
• Essential tremor (Minor's disease) is a hereditary benign disease manifested by non-progressive tremor, which is usually more pronounced in the neck muscles (head tremors). Often the disease begins in childhood.
• Excess thyroid hormones (thyrotoxicosis) and some other dyshormonal conditions (for example, hyperparathyroidism).
• Abuse of alcohol, drugs, psychoactive drugs, poisoning with mercury, lead, arsenic, carbon monoxide and some other compounds, including side effects of medications.
• Various vascular, post-traumatic, degenerative, inflammatory and demyelinating diseases, in which the death of nerve cells occurs, including those responsible for the control of muscle tone and coordination of movements (which is manifested by the development of tremor).
• Hysterical tremor - is constant or paroxysmal in nature, with variable rhythm and amplitude, intensified under the influence of psychogenic factors; observed in hysteria.

Basic forms of tremor

Neurologists distinguish two main forms of tremor (both of these forms can be of both pathological and physiological types):

Static tremor(resting tremor) - present and most pronounced in a resting, unstrained muscle - detected, for example, when the patient sits in a relaxed position, hands on the knees, thumbs up, palms inward. Sometimes it only takes a few seconds for a doctor to detect the presence of tremors in a patient with Parkinson's disease. It is much more difficult to identify the cause of trembling in children. It is almost impossible to persuade a child to relax during an appointment, so be prepared that the consultation may take a lot of time.

Dynamic tremor(promotional) - appears or intensifies with active movements in the muscle. There are postural (postural) action tremor (appears or intensifies when maintaining a certain posture - for example, holding straight arms in front of you), contraction tremor (appears or intensifies when maintaining muscle contraction - for example, prolonged clenching of a fist) and intention tremor (appears when performing precise small movements - for example, when trying to touch your nose with the tip of your finger).

In order to make a correct diagnosis, the doctor must conduct several different tests. For example, a doctor may ask a patient to drink from a glass, stretch out his arms, march in place, write something, or draw a spiral. And since tremor can be caused by a large number of reasons, if it occurs, it is necessary to undergo a comprehensive medical examination. These are blood tests (general, biochemistry, electrolytes, hormonal levels), ECG, measurement of blood pressure and pulse at rest and during exercise, examination of the fundus and measurement of intraocular pressure.

But although there are a number of scientific methods for studying tremor, the doctor's perspective and experience remain the main tools in the diagnosis process. Therefore, any continuous trembling is a reason to consult a doctor. Convincing oneself that “it’s just age-related” or “it will grow out and pass,” “everything will get better on vacation,” a person most often only aggravates the problem.

Sometimes your doctor may suggest computed tomography (CT) or magnetic resonance imaging (MRI) as an additional diagnostic test. This usually happens if the doctor, during examination, finds the so-called “focal symptoms”, i.e. indirect signs of damage to any part of the brain - brain or spinal cord. In case of tremor, CT/MRI should be performed to determine the cause of the tremor.

In advanced cases, doctors refuse to conduct the study, since during diagnosis it is necessary for the patient to be completely relaxed and not move the body and limbs. Therefore, first, the doctor, when prescribing medications, will try, together with the patient, to reduce tremors.

So, the diagnosis has been received and treatment has been prescribed. It is necessary to understand that tremor needs to be treated at any age, since in older people tremors can progress much faster and lead to a complete loss of the ability to self-care, and in children it sharply limits the possibilities of choosing a profession in the future.

If tremor occurs only during emotional stress, then, as a rule, they limit themselves to a single dose of drugs with a sedative and hypnotic effect.

For the treatment of more serious types of tremors, beta blockers, anticonvulsants (anticonvulsants, antiepileptics), dopaminergic drugs, dopamine agonists, indirect dopaminomimetics, dopaminolesinhibitors, central anticholinergics and - very rarely - antipsychotics are used.

Previously, large doses of B vitamins were also used to treat tremors. These substances either suppress the electrical activity of the brain, or are “simulators” of substances missing in the brain, or prevent their premature destruction. More effective medications have now been developed, and an excess of B vitamins can cause a lot of side effects, ranging from allergic dermatitis to liver and kidney dysfunction. The prescribing of this group of drugs to older people began to be treated with caution.

Most often, the doctor takes a long time to select the dose and frequency of administration of the drug to treat tremors, sometimes changing the medicine as needed. Unfortunately, it is impossible to immediately understand which medicine will work best. Most medications are taken for life, and there is no guarantee that the disease will not progress further.

It happens that the tremor is not amenable to conservative treatment, then the question of surgical stereotaxic intervention is raised. High-frequency electrical stimulation of certain parts of the brain using implanted electrodes or (less often and mainly with unilateral tremor) destruction of a separate area is used. Currently, such operations are performed only on adults.

It is very difficult to completely cure tremors. Modern medicines and procedures are aimed only at relieving symptoms and improving the quality of life of patients.

These tips apply mostly to adults. No matter how trite it sounds, but in order to prevent an exacerbation of the disease, it is necessary to follow a healthy lifestyle, limit coffee consumption (or better, completely exclude it from the diet), do not smoke, do not abuse alcohol, and avoid stressful situations if possible.

Of great importance physical activity. Take up any sport that doesn't require extra effort. Swimming or a light jog in the morning is great. Attach a cuff weighing 0.5 to 1 kg to your wrist or elbow while you eat, clean or do other light activities. This will help you control the tremors. But you should not carry a load during sports or physical activity. Be careful! With prolonged use of the load, muscle fatigue and increased tremor may occur.

Helpful advice:
Immediately before starting any work, sit in a chair with your hands on the armrests. Grasp the handrails tightly with your palms. Then, keeping your elbows still, gently rest your hands on the chair rails for a minute or two. Holding your hands in this motionless position helps to fatigue the muscles and reduces tremors for a short time.

Learn to relax: Stress and anxiety tend to increase tremors, so relaxing may reduce the tremors. Although it is impossible to completely eliminate stress from your life, you can change the way you react to stressful situations by using a range of relaxation techniques, massage or meditation.

Try to change your lifestyle. Use your less tremulous hand. Find ways to avoid writing documents, for example, use bank cards to avoid counting out bills and coins in stores. Try using voice dialing on your mobile phone and speech recognition software on your computer.

The doctor can offer other options for adapting to everyday life, the main thing is to interact with him, and not wait for the disease to “go away on its own.”

Valentina Saratovskaya

Photo thinkstockphotos.com

Tremor is hyperkinesis, which is manifested by involuntary oscillatory rhythmic movements of a part (limbs, head) or the whole body as a result of constant repetition of muscle contraction and relaxation. It is one of the most common extrapyramidal disorders. Quite often, tremor is familial in nature, in some cases it is of poor quality and has an extremely severe course.

Tremor: causes and development factors

The structures of the nervous system responsible for the occurrence of tremor have not been sufficiently studied.

Pathological tremor can be postural, intentional, static, or mixed.

Static tremor is observed in parkinsonism, essential tremor, hepatocerebral dystrophy, and mercury poisoning.

Postural tremor is observed in cases of lithium poisoning, alcohol poisoning, thyrotoxicosis, and parkinsonism.

Tremors are often observed in a state of fatigue or anxiety.

Intention tremor appears when the cerebellum or its connections are damaged.

Types of disease: classification of tremor

According to the frequency of oscillatory movements during tremor:

• slow tremor (3-5 Hz);
• rapid tremor (6-12 Hz).

By the nature of the movements:

• tremor of the “no-no” type;
• tremor of the “yes-yes” type;
• tremors like pill rolling;
• tremor like counting coins.

Depending on the location of the tremor:

• head tremor;
• tremor of the hands;
• tongue tremor;
• tremor of the feet.

Depending on the conditions of occurrence:

• static tremor - occurs in a part of the body that is at rest;
• intentional (dynamic) - appears during muscle activity;
• postural - occurs when maintaining a position, maintaining a pose;
• mixed - occurs both at rest and during movement.

Depending on the reasons:

• hysterical;
• senile;
• emotional;
• mercury;
• alcoholic;
• with thyrotoxicosis;
• with lesions of the cerebellum;
• essential;
• parkinsonian.

Symptoms of tremor: how the disease manifests itself

• Physiological tremor- rapid and mild tremor of the eyelids, fingers, and head, which occurs during muscle activity, tension, cooling, overwork, and emotional excitement.
• Senile (or senile) tremor- mixed trembling of the fingers, lower jaw, head, which does not have a significant effect on human movements.
• Drug tremor- this type of tremor is caused by phosphodiesterase inhibitors (caffeine, aminophylline), glucocorticosteroids, β-adrenergic receptor agonists, lithium drugs, antipsychotics, valproate, tricyclic antidepressants, amiodarone, psychostimulants.
• Mercury tremor observed in case of mercury poisoning, occurs at rest, intensifies with voluntary muscle movements. Mercury tremor manifests itself in the muscles of the face, and then the limbs.
• Alcohol tremors manifests itself in the form of trembling of the fingers of outstretched arms, which are apart, as well as the muscles of the face and tongue. Alcohol tremor occurs during alcohol intoxication, alcoholism, and withdrawal syndrome.
• Hysterical tremor observed in hysteria, has variable amplitude and rhythm, is constant or paroxysmal in nature, and intensifies under the influence of psychological factors.
• Tremor due to cerebellar lesions is intentional and is manifested by rhythmic vibrations of the limbs as they approach the target (for example, when touching the tip of the nose with one’s hand). Tremor can be of a postural nature, occurring when maintaining a certain posture or holding a weight.
• Essential tremor can occur both when performing actions and when maintaining a position, maintaining a pose. The tremor is bilateral, but can be asymmetrical. In addition to the extremities, the head (of the “no-no” or “yes-yes” type), lower jaw, legs, and vocal cords may be involved. Intellectual abilities are preserved. In half of the cases, essential tremor is a hereditary disease with an autosomal dominant pattern of inheritance, although there is an opinion about the possibility of damage to the efferent pathways of the cerebellum.

Patient actions for tremor

The appearance of tremor is a reason to consult a doctor and undergo an examination. It is necessary to determine the type of tremor, the reasons for its development, and also carry out the necessary therapeutic measures to eliminate the problem and improve the patient’s quality of life.

Diagnosis of measles

For tremor, doctors perform a series of instrumental diagnostic methods to determine the causes of symptoms. Among the examination methods for tremor, the most commonly used are:

• The “rapid” method (film shooting) is a high frequency of shooting followed by projection of the captured frames in slow motion.
• Tremography - registration of tremor in three planes.
• Dark photography - luminous elements are fixed on certain segments of the limb that is involved in the tremor. In the dark, vibrations of luminous elements are photographed on film.
• Electromyography is a muscle study that gives an idea of ​​the characteristics of rhythmic hyperkinesis.
• Other research methods are used at the discretion of the doctor, depending on the patient’s health condition and the severity of pathological signs.

If the tremor manifests itself in a mild form, then its treatment is reduced to the prescription of relaxing techniques. It is important to learn to avoid stress and relieve tension with the help of breathing exercises and other techniques that your doctor will recommend to you. Relaxing baths using soothing essential oils and herbs help. The patient may be prescribed sedatives of natural or synthetic origin. If the tremor is not malignant in nature and occurs in a mild form, then, as a rule, the above-mentioned procedures should be sufficient to eliminate painful symptoms and relieve nervous tension.

As for severe tremor, which prevents the patient from living and working normally, in this case, potent drugs are used to relieve this problem. As a rule, these are beta-blockers, which in fairly low dosages can reduce the amplitude of trembling. These drugs significantly improve the patient's condition and quickly eliminate the clinical manifestations of the pathological process.

In the treatment of essential tremor, β-adrenergic receptor antagonists, benzodiazepines (clonazepam), and primidone are used. Tolerance may develop to the effects of these agents, so they are recommended to be used only when necessary.

Drug therapy for cerebellar tremor is usually ineffective. There are reports of the successful use of clonazepam and primidone.

Surgical methods such as stereotactic thalamotomy and microstimulation of the thalamus are effective in treating severe cerebellar tremor. This is the latest treatment method, which is now successfully used in Europe, Israel, the USA and Japan. With deep brain stimulation, electrodes are implanted in the patient's brain area, stimulating (or suppressing) the activity of individual areas responsible for coordination of movements and tremors. This treatment method is currently being improved, and it is actively used in the treatment of diseases such as Parkinson's disease, epilepsy and others.

Complications of tremor

The main complication observed with tremor is a decrease (or complete loss) of ability to work. In severe forms of tremor, it is difficult for the patient to even do basic things: eat or get dressed. In such cases, the patient cannot do without outside help.

Tremor prevention

Avoiding bad habits and taking medications that can cause tremors.

Tremor or trembling are rhythmic movements that occur during involuntary contraction and relaxation of muscles.

How to find out whether this is a pathology or a temporary manifestation of central nervous system disorders?

There are two types

1. Tremor of the limbs and trunk– movements with a frequency of up to 10 Hz (up to 10 repetitions per second), which causes constant adjustments to the body’s motor system, both during movement and at rest. With strong emotions or heavy loads, the manifestations of tremor intensify.
2. Second type of tremor- These are fixation eye movements characterized by high frequency but low amplitude.

Tremor of the limbs is rightfully considered the most common disorder of human motor function. The cause of tremor can be poor genetics, but sometimes tremor appears as a consequence of a serious illness.

Causes of tremor

If you have trembling for more than 2 weeks, which does not depend on physical activity and emotional experiences, then most likely it is caused by a pathology in the body.

Pathological tremor can occur against the background of a serious illness in a number of other symptoms. A concussion can also cause tremors in the limbs. Trembling does not go away on its own.

The following types are distinguished:

Symptoms of the disease

Rhythmic vibrations of body parts that are visible to the naked eye.

This may be, for example, trembling of outstretched arms, twitching of legs.

Due to its prevalence diagnosing tremor does not cause difficulties for doctors. In some difficult-to-diagnose cases, rapid (high-speed) shooting or a thermograph (a device that records shaking in three planes) is prescribed.

Some types of tremors are determined using laboratory tests, for example in cases of thyroid disease.

Treatment of limb tremor

If the disease is not malignant, then it is enough to join relaxation procedures that relieve nervous tension, and the tremor will go away. Additionally, breathing exercises, sedatives and special baths are prescribed.

For pathological tremor

In the case of a mild form, the patient does not require special treatment; he needs to avoid uncomfortable positions, keep objects close to the body and grasp them firmly.

If a person needs to perform precise actions at work or an illness interferes with handling utensils, then drug treatment with beta blockers is prescribed, which reduce the amplitude of trembling, or completely eliminate the manifestations of the pathology.

But over time, the body can develop an addiction, so it is recommended to use the medicine before an important event or during stressful situations.

Alcohol can relieve tremors, but constant drinking is a sure path to alcoholism.

Therefore, alcohol in small quantities is consumed immediately before meals, then the patient can have lunch calmly.

In especially severe cases, when a person is diagnosed with a disability, surgery can help, in which the cerebellum area is stimulated with an electric current.

In conclusion, pathological tremor is almost impossible to overcome, but modern medications and advances in neurosurgery will help the patient again become a full-fledged member of society, and not be a burden to his loved ones.