Muscle tremors. Why does tremor of the limbs and head appear: causes, types, diagnosis and treatment prognosis

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The most common type of involuntary muscle movement,tremor- These are regular rhythmic oscillations caused by the alternating contraction of opposing muscle groups.

Tremor is a typical symptom of cerebellar and extrapyramidal disorders, as well as a side effect of certain medications and drugs.

Main types of tremor:

Rest tremor. It occurs at rest, when a person does not take any action and is relaxed. This type of tremor is characteristic of Parkinson's disease.

Action tremor, or action tremor. Occurs when trying to make any movement. This type of tremor is characteristic of alcohol withdrawal syndrome.

Postural tremor. This type of tremor occurs when trying to maintain a certain posture or body position.

Possible causes of tremor:

1. Alcohol withdrawal syndrome. With severe dependence, in the first days without alcohol, patients may experience tremor of action. It occurs 6-8 hours after the last drink and gets worse quickly. Other early signs include: irritability, restlessness, insomnia, headaches, tachycardia, high blood pressure, nausea and vomiting. In severe cases, hallucinations, delusions, and seizures may occur.

2. Alkalosis – a change in blood pH towards the alkaline side. Severe alkalosis can cause severe movement tremors, muscle twitching, agitation, sweating, and hyperventilation. Patients may complain of dizziness, ringing in the ears and paresthesia (impaired sensitivity).

3. Benign familial essential tremor. This disease occurs in young people. It is characterized by bilateral tremor, which usually begins in the fingers and hands and can spread to the head, jaws, lips, and tongue. Involvement of the larynx causes the voice to tremble.

4. Cerebellar tumor. Action tremor is an important symptom of this disease. Other signs include ataxia, nystagmus, incoordination, muscle weakness and atrophy, and weakened or absent deep tendon reflexes.

5. General paresis. This condition may be a consequence of neurosyphilis and is accompanied by tremor of action. Other manifestations: ataxia, positive Babinski sign, dull headache.

6. Graves' disease. Symptoms of this disease include hand tremors, weight loss, weakness, heat intolerance, and shortness of breath. Also characterized by an enlarged thyroid gland (goiter) and exophthalmos (displacement of the eyeballs forward, “protrusion”).

7. Hypercapnia. An increase in the partial pressure of carbon dioxide (CO2) in the blood can cause the limbs to tremble when moving. Signs of increased CO2 levels include headache, blurred vision, weakness, drowsiness, and decreased level of consciousness.

8. Hypoglycemia – low blood sugar. In acute hypoglycemia, action tremor develops, accompanied by confusion, weakness, tachycardia, sweating, and cold, clammy skin. Early complaints usually include headache, extreme hunger, nervousness, double vision or blurred vision. As the condition worsens, the tremor may disappear, hypotension occurs, and consciousness is impaired.

9. Kwashiorkor. In the later stages of this disease, trembling may occur, both at rest and during large movements. Examination reveals myoclonus, rigidity of all extremities, hyperreflexia, swelling of the arms and legs, hair loss, dryness and flaking of the skin.

10. Multiple sclerosis is a severe, progressive neurodegenerative disease. Tremor when moving can appear and disappear - this is one of the early signs of the disease. Visual and sensory disturbances, nystagmus, muscle weakness, paralysis, spasms, hyperreflexia, impaired swallowing, and ataxia also occur. Constipation, frequent urge to urinate and urinary incontinence, and impotence may be a concern.

11. Parkinson's disease. The classic sign of this degenerative disease is resting tremor. It usually starts in the fingers and affects the hands and feet, eyelids, jaw, lips, and tongue. Patients' hands tremble slowly and rhythmically. An attempt to cover the eyelids causes them to flutter.

The jaws may move up and down rhythmically. The protruding tongue can move back and forth in rhythm with other parts of the body. The frequency of the tremor remains constant, but its amplitude changes over time. Other characteristic signs: bradykinesia, disturbances in gait and posture, monotonous voice, mask-like face, difficulty swallowing, blepharospasm (the eyelids may close completely).

12. Porphyria. Involvement of the basal ganglia in porphyria can cause resting tremor, chorea, and muscle rigidity. As the disease progresses, generalized seizures with aphasia and hemiplegia occur.

13. Thalamic syndrome. Different types of thalamic syndrome can cause different combinations of tremors, profound sensory loss, and hemiataxia.

14. Thyrotoxicosis. Neuromuscular effects of this disease include action tremor, myoclonus, and hyperreflexia. Other signs of thyrotoxicosis: tachycardia, arrhythmias, anxiety, shortness of breath, sweating, heat intolerance, weight loss due to increased appetite, diarrhea. There is an enlarged thyroid gland and exophthalmos.

15. Wernicke's encephalitis is a disease that occurs due to a deficiency of vitamin B1 (thiamine), mainly in alcoholics. Causes tremors when moving. Other signs of the disease: apathy, ataxia, nystagmus, orthostatic hypotension, tachycardia, confusion and others.

16. West Nile encephalitis. This viral infection is characteristic of Africa and the Middle East and is transmitted by local mosquito bites. Cases of the disease are also observed among tourists. Mild infections include fever, headache and muscle pain, usually accompanied by a rash and swollen lymph nodes. In severe forms of the disease, the fever is high, stiffness of the neck muscles, disorientation, stupor, coma, tremors, seizures and paralysis occur. Sometimes leads to death.

17. Wilson's disease is a disorder of copper metabolism in the body. Tremor in Wilson's disease occurs early and progresses as the disease progresses. A characteristic sign of the disease is Kayser-Fleischner rings on the cornea. Other signs: incoordination, chorea, ataxia, muscle spasms and rigidity, weakness, personality disorder, seizures, hypotension. Jaundice, hyperpigmentation (bronze skin), enlarged liver and spleen, and ascites may occur.

18. Medicines. Phenothiazines (Fluphenazine) and other antipsychotics may cause tremors at rest. Metoclopramide and metyrosine also sometimes cause tremors. Intoxication with large doses of lithium, terbutaline, pseudoephedrine, amphetamines and phenytoin causes tremors, which disappear when the dose is reduced.

19. Medicinal plants. Herbal materials containing ephedrine (ma huang and other types of ephedra) can cause a variety of cardiovascular and nervous system side effects, including tremors.

20. Manganese poisoning. Early signs of manganese poisoning: resting tremor, chorea, amnesia, personality changes, mask-like face.

21. Mercury poisoning. Chronic mercury poisoning is characterized by irritability, excess saliva, tooth loss, gum disease, slurred speech and tremors.

22. Tremor in newborns may have specific pediatric causes, including cerebral palsy, fetal alcohol syndrome, and maternal drug use during pregnancy.

: Master of Pharmacy and professional medical translator

Review

Tremor is uncontrollable shaking in various parts of the body. The most common symptoms are hand tremors and head tremors.

Normally, every person experiences slight trembling of body parts, which intensifies in older people. For example, if you stretch your arms out in front of you, you may notice that they are shaking slightly. A more noticeable tremor appears during times of excitement, fear, when a person is angry or under stress. This is normal and is associated with an increase in adrenaline levels in the blood. Sometimes a temporary cause of tremors can be the use of medications, for example, anti-asthma or antidepressants.

In general, trembling of the hands, head, face and other parts of the body is a common disorder of motor activity. But in most cases, this disorder causes only mild anxiety. Only in some people, over time, body tremors can intensify and turn into pathological.

At the beginning of the disease, the arms and hands shake, but gradually the tremor can affect other parts of the body, for example, the head, face, jaw, tongue. When the vocal cords are involved in the process, the voice begins to tremble. In the most severe cases, small involuntary movements make it nearly impossible for a person to carry out daily activities. The greatest difficulties are caused by writing by hand, tying shoelaces, a person becomes unable to drink a glass of water, etc. With the help of medications, in most cases, it is possible to significantly reduce the manifestations of tremor.

Symptoms of tremor (shaking)

The only symptom of tremor is a characteristic trembling of body parts. In about 9 out of 10 cases, this looks like frequent movements of the hands up and down with a small amplitude. Other parts of the body may also be affected:

head;
jaw;
lips;
language;
muscles and ligaments of the larynx (including vocal ligaments);
legs.

Tremors can appear at any age, even in children. The later the trembling in the body occurs, the better the prognosis of the disease and the easier its manifestation.

More often, the tremor affects both sides of the body equally and intensifies with muscle tension: when you try to hold the body in a certain position or do something with your hands, for example, write. At rest, trembling is usually weak or absent. Trembling in the hands and body can increase:

stress;
anxiety;
caffeine (found in tea, coffee, chocolate and some carbonated drinks);
some medications.

Causes of tremor (shaking)

One of the causes of tremor is a hereditary predisposition. Research results suggest that a mutation in one of the genes leads to damage to certain parts of the brain, which disrupts the conduction of nerve impulses from the brain to the muscles. Such a tremor is called essential, primary, that is, its appearance is not directly related to other diseases, environmental influences and other factors. However, certain activities may worsen its symptoms, such as:

laborious work requiring fine motor skills, such as embroidery or handwriting;
eating;
applying makeup;
shaving.

If you are tired, anxious, hot or cold, this can also make your symptoms worse.

Essential tremor with a hereditary predisposition occurs in at least half of cases of body tremors. If one of your parents has an abnormal gene that causes tremors, you have a 50% chance of having the disorder. However, the age at which tremor develops, as well as the severity of it, may vary among family members. You can be a carrier of a mutant gene, but remain healthy, since the mutated gene does not always manifest itself. Additionally, some people may develop this mutation spontaneously rather than being passed on from their parents.

In other cases, tremor develops secondary, that is, it is caused by existing diseases or conditions, for example:

overactive thyroid gland (hyperthyroidism);
Parkinson's disease is a chronic disease that impairs the brain's ability to coordinate movements;
Multiple sclerosis is a disease of the central nervous system (brain and spinal cord) that impairs sensory perception and body movements;
dystonia is a neurological syndrome in which involuntary muscle spasms occur;
In extremely rare cases, a stroke can cause tremors along with several other symptoms;
peripheral neuropathy - damage to the peripheral nervous system;
alcohol withdrawal syndrome (alcohol withdrawal) can occur in people who were dependent on alcohol but have stopped drinking or reduced their consumption;
amphetamines and other stimulants;
medications, such as some antidepressants and asthma medications;
caffeine found in tea, coffee and some carbonated drinks.

Treatment of tremor (body shaking)

In most cases, the treatment of tremor is the prescription of symptomatic therapy in order to reduce the manifestation of movement disorders. If the tremor is mild and does not interfere with daily activities, you can temporarily postpone treatment. Body tremors in such a situation can be significantly reduced by abstaining from triggers such as caffeine and stress, as well as by maintaining a healthy lifestyle and getting enough sleep. However, doctors often recommend starting treatment for tremor in the early stages, since in the future, without treatment, it can quickly progress.

As a rule, to reduce tremors in the hands, head and other parts of the body, drugs from the following groups are prescribed:

beta blockers,
anticonvulsants,
botulinum toxin injections, etc.

In severe cases, surgical treatment is resorted to.

Treating tremors with medications

Beta blockers: Propranolol, atenolol, metoprolol and others are most often prescribed for the treatment of essential tremor. These remedies are widely known for treating high blood pressure (hypertension) and heart disease, but also help reduce body tremors. Typically, 50-70% of people with tremor report that their symptoms have improved since treatment began. Possible side effects of beta blockers:

nausea;
dizziness;
cold hands and feet;
impaired potency in men.

These drugs are not suitable for people with diabetes, bronchial asthma, and certain types of arrhythmia.

Anticonvulsants is also widely used in the treatment of essential tremor, as well as epilepsy. These include: primidone, topiramate, gabapentin and other drugs. If these drugs alone do not help, you may be prescribed a combination of them. Although effective, the drugs are often poorly tolerated, causing low blood pressure, drowsiness, and nausea.

Diazepam-type sedatives, for example, clonazepam, alprazolam, lorazepam and others are prescribed in cases where the combination of the above methods did not help. Sedatives can help relieve tremors by reducing the anxiety that often worsens body tremors. The disadvantages of these drugs are side effects: drowsiness and addiction.

Botulinum toxin used when the drugs described above are not effective. Botulinum toxin is injected directly into the muscles subject to tremor and, by blocking the transmission of nerve impulses, relaxes them. Botulinum toxin is a strong poison, but in small doses it is not dangerous to health. Botulinum toxin has the greatest effect on tremor caused by dystonia.

Sometimes pathological tremor can be so severe that it noticeably interferes with normal life and does not respond to drug treatment. Then they decide whether to perform a surgical operation.

Surgical treatment of tremor

Deep brain stimulation is a completely reversible minimally invasive operation, which consists of introducing one or more electrodes (thin metal needles) into a certain part of the thalamus (brain). The electrodes are connected to a pulse generator (a device similar to a pacemaker), which is placed under the skin on the chest. The generator produces an electrical current that affects areas of the brain that block tremor. According to some reports, deep brain stimulation can reduce tremors by 90%.

During deep brain stimulation, various types of anesthesia are used to make the operation painless. Features of anesthesia include the need to remain conscious most of the time, so that surgeons can ensure the correct installation and operation of the generator.

Possible side effects of deep brain stimulation:

surgical infection;
speech disorder;
tingling;
cerebral hemorrhage;
stroke;
complications of anesthesia.

However, recent studies have shown that deep brain stimulation is a relatively safe procedure. Some side effects can be avoided by adjusting the operating mode of the pulse generator.

Thalamotomy for the treatment of tremor involves making a small hole in the thalamus, the same part of the brain where deep stimulation is performed. This procedure has been proven effective in treating tremor. Deep brain stimulation is often preferred over thalamotomies because the procedure is completely reversible and usually has fewer side effects. However, thalamotomy has its own advantages, such as eliminating the need for follow-up visits to the doctor to check the pulse generator and replace batteries.

All site materials have been checked by doctors. However, even the most reliable article does not allow us to take into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. The articles have been prepared for informational purposes and are advisory in nature.

Tiki are short-term repeated stereotypic, in most cases motor (rotation of the head, grimaces, protrusion of the tongue, raising of the shoulders, etc.), sometimes vocal (coughing, sobbing, sniffing, etc.), sensory or mental phenomena that can be arbitrarily suspended (suppressed) for a while. Repeated vocalizations or actions, such as imitative phenomena (called echolalia/echopraxia or palilalia/palypraxia), are complex tics. They may be obscene (coprolalia/copropraxia). Along with idiopathic tics, secondary forms are also known - with obsessive-compulsive disorder syndrome and with the use of certain medications (neuroleptics, antiepileptic drugs). Often tics are accompanied by mental disorders.

- Localized ticks, for example in the facial area, develop primarily in children and can be observed for a short period of time.
- Generalized tics represent Gilles de la Tourette syndrome: it is characterized by a combination of motor and vocal tics, the onset of the disease before the 20th year of life and the duration of the disease more than one year. The familial nature of this disease is rarely observed.

Tremor- rhythmic, regular, stereotypical movements with different frequencies, characteristic of each specific form of tremor, and most often with a small volume of movement. Differential diagnosis is carried out, for example, taking into account the conditions in which tremor appears or intensifies.

- Physiological tremor with a frequency of 8-12 per second has a very low amplitude; auxiliary means are usually required to detect it.
- At rest tremor trembling occurs when parts of the body are not subject to gravity. This is characteristic of parkinsonian tremor. It is accentuated in the distal parts of the limbs, the frequency is 4-6 per second, the amplitude is relatively high, and flexion and extension movements of the hand and fingers are characteristic. During intentional movements it temporarily disappears. Less commonly, resting tremor is observed in elderly patients in the absence of other manifestations of parkinsonism. in these cases it does not progress; the head is sometimes involved in the process, and it is also characteristic of Wilson's disease.
- Promotional tremor appears when muscles tense: either when holding a part of the body against gravity (postural tremor), or when making a movement (kinetic tremor): predominates in the distal parts of the limbs. The most common cause is essential tremor (in old age they talk about senile tremor), 60% of cases are hereditary. The frequency is 8-13 per second, over time it decreases and the amplitude increases. Typical situations in which essential tremor intensifies and interferes with daily activities include, for example, thoroughly stirring sugar in a glass.

Special shape promotional tremor is asterixis (“flapping tremor”) - somewhat uneven flexion and extension of the hands, which is characteristic of liver diseases, as well as Wilson’s disease and some poisonings. Currently, it is interpreted as pathological myoclonus (see above).
- Rubral tremor(synonyms - mesencephalic, Holmes tremor) is a combination of a slow (3-4 Hz) resting tremor with an action (usually more pronounced) tremor, which is observed with lesions of the midbrain.

Tremor usually observed in polyneuropathies.
Intention tremor, also called atheistic, is always associated with cerebellar ataxia and is a consequence of damage to the dentate nucleus or its efferent connections. It is absent at rest, but during intentional movement it becomes more pronounced, the more precise the movement needs to be carried out and the closer the body part is to the intended goal. For example, it is clearly visible when performing a finger-nose test. This form of tremor occurs especially often in multiple sclerosis. The term primary orthostatic tremor refers to uncertainty when standing, which is accompanied by high-frequency synchronous tremor of the leg muscles, detected only by electrophysiological studies. A special form is psychogenic tremor. It can simulate any type of tremor.

Especially often it is limited to one limb, is irregular, high-amplitude and in most cases is dramatic, impressive character. When the patient's attention is distracted, the tremor decreases or disappears. When a trembling part of the body is passively fixed, another part begins to tremble. A generalized form of psychogenic tremor was described in soldiers during the First World War. In Charcot-Marie-Tooth disease, inherited in an X-linked pattern, tremor and paroxysmal short-term dysfunction of the central nervous system, as well as signal changes on MRI of the skull, have been described. A premutation in the fragility X gene may be accompanied by intention tremor, ataxia, gait impairment, and cognitive impairment in older men.

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. Causes

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 can again lead to the appearance of trembling.

Sometimes depression or strong emotions can manifest themselves as such an uncontrollable “chill-like” tremor of the whole body that the person literally “stabs.” But this condition passes. Therefore, doctors advise not to treat tremor that appears during severe fatigue, emotional stress or severe anxiety, but only observe it.

Physiological tremor occurs, as a rule, 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 disrupted. The gait does not change. Treatment for this type of tremor is not required in most cases.

Sometimes physiological tremor includes trembling during hypothermia and increased temperature, abuse of coffee and energy drinks, single use of psychoactive substances (for example, sleeping pills, sedatives or use of an inhaler for the treatment of bronchial asthma), hypoglycemia (including an overdose of hypoglycemic drugs or fasting, prolonged strict diet combined with physical stress), as well as twitching of the eyelids or muscles of half the face (hemifacial spasm). However, in different classifications this type of jitter is interpreted differently.

One condition unites all these conditions: when the provoking factor disappears, the tremor also disappears. For example, physiological tremor includes trembling of the limbs during a single dose of alcohol, although more often, after taking a little on the chest, a person is surprised to discover that the “shaking” is over. Alas, alcohol does not cure tremors, and regular use of it 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 in 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). The disease often 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).

Diagnostic features

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. What to do next? Entire article by Valentina Saratovskaya