Muscle tremor causes. Hand shake: possible causes

Tremor is the process of involuntary trembling 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 exercise or stress. Why does trembling occur, can it be controlled and when should I see a doctor?

General characteristics of the state

Tremor is an involuntary rhythmic muscle contraction that a person cannot control. One or more parts of the body are involved in the process (most often occurs in the limbs, less often in the head, vocal cords, trunk). Patients of the older age category are most susceptible to chaotic muscle contractions. This is due to the weakening of the protective functions of the immune system and concomitant diseases. In general, tremor does not pose a serious threat to life, but significantly reduces its quality. The trembling can be so strong that it makes it impossible for a person to lift small objects or sleep peacefully.

Possible causes of 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, neurodegenerative diseases (for example, Parkinson's disease). They can also indicate kidney / liver failure or a malfunction of the thyroid gland. In medical practice, there is often a predisposition to tremor due to genetic factors.

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

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

Classification of involuntary contractions

Doctors divide tremor into 4 categories - primary, secondary, psychogenic and trembling in 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 a manifestation of serious diseases that need medical attention.

Classification according to the mechanism of occurrence

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

Resting tremor occurs only in a relaxed state and disappears or partially dulls during movement. Most often, the symptom indicates a progressive neurological disease. As the disease progresses, the amplitude of fluctuations slowly increases, which seriously impairs the quality of life and limits the functionality of a person.

Types of tremor

The main types of tremor include:

1. Physiological tremor. Most often localized in the hands and practically not felt by a person. It is of a short-term nature and occurs against the background of anxiety, overwork, exposure to low temperatures, alcohol intoxication or chemical poisoning. Also, physiological trembling 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 trembling, most often caused by a genetic predisposition.
4. Essential tremor. In most cases, localized in the hands, is bilateral. Muscle contractions can cover not only the arms, but also the torso, head, lips, legs, and even the vocal cords. Essential tremor is genetically transmitted. It is often accompanied by a mild degree of torticollis, muscle tone in the extremities, and spasm during writing.
5. Iatrogenic or drug tremor. Occurs as a side effect from the use of drugs or unskilled actions of a doctor.
6. Parkinsonian tremor. This is the so-called "quivering rest", which weakens at the moment of movement or any other activity. The symptom is characteristic of Parkinson's disease, but can also occur in other diseases with parkinsonism syndrome (for example, multiple system atrophy). Most often localized in the hands, sometimes the legs, lips, chin are involved in the process, less often the head.
7. Cerebellar tremor. This is an intentional tremor, less often manifested as postural. The body is involved in the process of trembling, less often the head.
8. Holmes tremor (rubral). A combination of involuntary postural and kinetic contractions that occurs at rest.

Features of therapy

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

How is tremor diagnosed?

Diagnosis is based on the study of the patient's medical history, physiological and neurological examination. At the stage of physiological examination, the doctor reveals the mechanism of development, localization and manifestations of tremor (amplitude, frequency). Neurological examination is necessary to compile a complete picture of the disease. Perhaps involuntary trembling is associated with impaired speech, 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 for the development of tremor (for example, malfunctioning of the thyroid gland). Subsequent diagnostic manipulations 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, they give a referral for CT or MRI, and with severe trembling (a person cannot hold a pen / fork) - for a functional study. The patient is offered to perform a series of exercises, according to which the doctor evaluates the state of his muscles and the reaction of the nervous system to a particular task. The exercises are very simple - touch your nose with your fingertip, bend or raise a limb, and so on.

Medical and surgical treatment

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

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

If medical 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 pulsed device is inserted under the skin of the chest. It generates electrodes, sends them to the thalamus (the deep brain structure responsible for movement), and thereby eliminates the tremor. 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, typing, cause difficulties or are completely impossible. Additionally, tremor limits social and physical activity. A person refuses to communicate, habitual employment, in order to avoid awkward situations, embarrassment and other things.

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

Tremor - involuntary vibrations 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, which requires, first of all, a correct syndromic description of tremor. In connection with the foregoing, great importance is attached to the principles of the 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 intentional tremor, then all types of trembling are described and recorded as separate independent types, necessarily emphasizing the relative severity of each of them. For example, a patient may have a gross resting tremor, a less pronounced postural tremor, and an even less pronounced intentional tremor. This picture is typical for pronounced tremulous forms of parkinsonism. The 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 intentional tremor (with lesions of the cerebellum).
• Other important principles for describing tremor are as follows:
  • 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 only the thumb or abdominal wall muscles, eyeball trembling or orthostatic tremor, distal or proximal trembling accentuation, symmetry/asymmetry).
  • Motor pattern of trembling (flexion-extension; pronation-supination; like "rolling pills", "yes-yes", "no-no"; flapping).
  • Amplitude-frequency characteristics, severity of trembling, features of its course (variants of the debut and subsequent dynamics).
  • Syndromic environment of tremor, that is, a description of those neurological symptoms against which tremor appears.

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

What causes a tremor?

• 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, Hallervorden-Spatz disease, etc.).
• Postural tremor (6-12 Hz).
  • Physiological tremor.
  • Enhanced (accentuated) physiological tremor (with stress, endocrine diseases, intoxication).
  • Benign essential tremor (4-12 Hz): autosomal dominant, sporadic, in combination with some diseases of the central nervous system (Parkinson's disease, dystonia) and peripheral nervous system (polyneuropathy, reflex sympathetic dystrophy).
  • With organic pathology of the brain (toxic, tumor and other lesions of the cerebellum, Wilson-Konovalov disease, neurosyphilis).
• Intentional 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, TBI, etc.).
• Rubral tremor.
• Psychogenic tremor.

Neurochemical changes in tremor

Examination of the brain of deceased patients with essential tremor did not reveal any specific pathomorphological changes or a specific neurochemical defect. Although lesions of the cerebellar efferents or afferents can cause tremor, whether it is based on any specific neurochemical defect remains unclear. Neuroimaging studies help to identify neural circles involved in the pathogenesis of tremor.

Types of tremor

Resting tremor

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

Postural tremor

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

Intention tremor

Intentional trembling 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 based on characteristic accompanying 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 cerebellar variants of tremor include not only intentional trembling, but also such phenomena as titubation, manifested by rhythmic oscillations of the head and sometimes the trunk (especially noticeable when the patient is standing), postural tremor of the proximal extremities (thigh or flat).

Rubral tremor

Rubral tremor (more correct name - midbrain tremor) is characterized by a combination of rest tremor (3-5 Hz), even more pronounced postural tremor and the most pronounced intentional tremor (intenpion tremor → postural tremor → rest tremor). It appears with damage to the midbrain during a stroke, traumatic brain injury, or, less commonly, with a tumor or demyelinating (multiple sclerosis) process in the legs: the brain. This tremor appears in the extremities opposite to 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 undulating (but not progressive) course, the presence of spontaneous remissions or remissions associated with psychotherapy, the “complex” nature of the tremor (all major types of tremor can be equally represented), the presence of clinical dissociations (selective preservation of some limb functions in the presence of gross trembling), placebo efficacy, as well as some additional signs (including complaints, anamnesis and neurological examination results) confirming the psychogenic nature of the disorder.

Physiological tremor

Physiological tremor is present in the norm, but is manifested by such small movements that it becomes noticeable only under certain conditions. Usually it is a postural and intentional tremor, low-amplitude and fast (8-13 in 1 second), which is revealed when the arms are extended. Physiological tremor increases in amplitude with anxiety, stress, fatigue, metabolic disorders (eg, hyperadrenergic states with alcohol withdrawal, drug withdrawal, or thyrotoxicosis), in response to certain drugs (eg, 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 the treatment of these conditions. Benzodiazepines by mouth 3–4 times daily (eg, diazepam 2–10 mg, lorazepam 1–2 mg, oxazepam 10–30 mg) help with chronic anxiety tremor, but should be avoided for long periods. Propranolol 20–80 mg orally 4 times a day (as with other beta-blockers) is often effective for drug-induced tremor or acute anxiety (eg, stage fright). If beta-blockers are ineffective or not tolerated, primidone 50-250 mg orally 3 times a day can be tried. Sometimes small doses of alcohol are effective.

Other types of tremor

As independent phenomena in the literature, the so-called dystonic tremor (trembling spastic torticollis, trembling writing spasm), the “rabbit” syndrome (neuroleptic trembling of the lower jaw and lips) is mentioned. Such rhythmic phenomena as asterixis (flapping, negative myoclonus), myorhythmia, segmental myoclonus are phenomenologically reminiscent of trembling, however, 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 a low amplitude and a high frequency (12 cycles/s). Physiological tremor increases after exercise, with thyrotoxicosis, taking various drugs, such as caffeine, adrenomimetics, lithium, valproic acid.

Essential tremor

The next frequent variant of tremor is the so-called essential, or family tremor, which is usually slower than increased physiological tremor. Essential tremor can involve the limbs 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 localization and severity of tremor within the same family varies significantly. The limbs may be involved asymmetrically, but a severely unilateral tremor is usually indicative of a different disorder. The tremor often improves with alcohol but is exacerbated by caffeine, stress, or concomitant thyrotoxicosis (as is increased physiological tremor). In different limbs, the tremor is asynchronous - in contrast to the synchronous rest tremor in Parkinson's disease. In this regard, the patient, who, due to tremor, is unable to hold a cup of liquid with one hand without spilling it, copes much better with this task, holding the cup with both hands - asynchronous hand movements 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 II types, GBS, uremic, alcoholic and other polyneuropathies).

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

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

1. Frequent (at least several times a week) or persistent tremor of the limbs and/or head.
2. The postural or kinetic nature of the tremor (there may be no intentional component).
3. The absence of other neurological diseases that can cause tremor.
4. No history of treatment with any drugs that can cause tremor.
5. Family history of similar tremors in other family members (confirm the diagnosis).

Tremor can occur in other extrapyramidal diseases, such as myoclonic dystonia, characterized by rapid muscle twitches. Orthostatic tremor and isolated postural tremor are distinguished as separate variants. 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 individual family cases, but so far it has not been possible to identify its product. It is possible that the disease is associated with multiple genes. Different families often differ in their reaction to alcohol, the presence of concomitant extrapyramidal syndromes (myoclonus, dystonia, parkinsonism). After identifying a genetic defect in different families, it will be possible to determine which clinical nuances 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 character. Low-frequency oscillations of the limb result from the instability of its proximal section. At the same time, the tremor disappears if the limb is stabilized. Differentiation of cerebellar and essential types of tremor usually does not cause difficulties. Cerebellar tremor intensifies as the limb approaches the target, while in essential tremor the amplitude of hyperkinesis remains approximately the same throughout the entire purposeful movement. With lesions of the cerebellum, in addition to tremor, there is also a pronounced violation of the 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. "Jibs" in this case are called tendons and ligaments of the knee joints. This apt definition was given by the people to the state when, from fright or in strong anger, the legs begin to tremble. But what if, in the normal state, hands and legs are shaking, or something like a “chill” shakes the body? Urgently run to the doctor or try to change your lifestyle?

Thrill of passion or nervous trembling?

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

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

Ophelia:
- I sewed. Hamlet enters.
Without a hat, a sleeveless jacket in half,
Stockings to the heels, stained, no garters,
Shaking so that you can hear how it knocks
Knee on knee, so confused
As if he was in hell and ran
Talk about the horrors of Gehenna.

Polonium:
- Maddened by passion?

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

We live in a very difficult time, full of worries and stressful situations. Increasingly, at a neurologist's appointment, 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 complain of hand tremors. People ask what can be done about it. And, of course, in each individual case, the answer of the doctor will be different. Let's try to figure out the reasons together.

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

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

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

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

In an overly emotional person, hand tremors can be observed almost constantly. However, as soon as a person calms down, the tremor noticeably decreases, and sometimes completely disappears. 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 state 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. Possible tremor of the head, chin, tongue, occasionally torso and legs. At the same time, a person can write with a pen, hold a cup, spoon and other objects.

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

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 fine-sweeping resting tremor. According to statistics, this disease usually develops in people over fifty-seven years old, but in our troubled times, the disease has noticeably “younger”.
• Essential tremor (Minor's disease) is a hereditary benign disease that manifests itself as a non-progressive tremor, which, as a rule, is more pronounced in the muscles of the neck (head tremor). 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, which are responsible, among other things, for controlling muscle tone and coordination of movements (which is manifested by the development of tremor).
• Hysterical tremor - is permanent or paroxysmal in nature, with an unstable rhythm and amplitude, increases under the influence of psychogenic factors; observed in hysteria.

The main forms of tremor

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

static tremor(resting tremor) - present and most pronounced in a resting, relaxed muscle - is detected, for example, when the patient sits in a relaxed position, hands are on their knees, thumbs up, palms inward. A few seconds is sometimes enough for a doctor to detect the presence of trembling 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 at the reception, so be prepared that the consultation can take a long time.

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

In order to correctly diagnose, the doctor necessarily conducts several different tests. For example, the doctor may ask the patient to drink from a glass, spread their arms, march in place, write something, draw a spiral. And since tremor can be caused by a large number of reasons, when 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 while there are a number of scientific methods for examining tremor, the physician's perspective and experience remain the main tools in the diagnosis process. Therefore, any incessant trembling is a reason to see a doctor. Persuading himself that “this is age-related” or “it will grow and pass”, “everything will get better on vacation”, a person most often only exacerbates the problem.

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

In advanced cases, doctors refuse to conduct a study, since during the diagnosis, complete relaxation of the patient and the absence of movements of the body and limbs are necessary. Therefore, at first the doctor, prescribing drugs, will try, together with the patient, to achieve a decrease in trembling.

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

If the tremor occurs only with emotional overstrain, then, as a rule, they are limited to a single dose of drugs with a calming and hypnotic effect.

More serious tremors are treated with beta-blockers, anticonvulsants (anticonvulsants, antiepileptics), dopaminergic drugs, dopamine agonists, indirect dopaminomimetics, dopaminolizate inhibitors, central anticholinergics, and, very rarely, antipsychotics.

Previously, large doses of B vitamins were also used to treat tremor. These substances either suppress the electrical activity of the brain, or are "imitators" of substances missing in the brain, or prevent their premature destruction. Now more effective medicines have been developed, and an excess of B vitamins can cause a lot of side effects, from allergic dermatitis to disruption of the liver and kidneys. The appointment of this group of drugs to the elderly began to be treated with caution.

Most often, the doctor selects the dose and frequency of administration of the drug for the treatment of trembling for a long time, sometimes changing the medicine as needed. Unfortunately, it is impossible to immediately understand which medicine will work in the best way. Most drugs 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 cure tremor completely. 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 does not require extra effort. Great for swimming or a light jog in the morning. 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 allow you to control the tremor. But you should not carry the load during sports activities or physical exertion. 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 firmly. Then, keeping your elbows still, gently rest your hands on the chair rails for one or two minutes. By holding your hands in such a stationary position, you contribute to muscle fatigue and weaken the tremor for a short time.

Learn to relax: Stress and anxiety tend to make tremors worse, so shaking can decrease when you relax. While it's impossible to completely eliminate stress from your life, you can change how you react to stressful situations using a range of relaxation techniques, massage, or meditation.

Try to change your lifestyle. Use the less tremor-prone hand. Find ways to avoid writing documents, for example, use bank cards to avoid counting 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, the tremor is familial, in some cases it is of poor quality and has an extremely severe course.

Tremor: causes and factors of development

The structures of the nervous system responsible for the occurrence of tremor are not well understood.

Pathological tremor is postural, intentional, static, mixed.

Static tremor is observed in parkinsonism, essential tremor, hepato-cerebral dystrophy, mercury poisoning.

Postural tremor is observed with lithium poisoning, alcohol, thyrotoxicosis, parkinsonism.

Tremor is often observed in a state of fatigue, anxiety.

Intentional tremor occurs 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);
• fast tremor (6-12 Hz).

By the nature of the movements:

• tremor of the "no-no" type;
• tremor of the "yes-yes" type;
• tremor like rolling pills;
• tremor like counting coins.

Depending on the location of the tremor:

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

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 posture;
• 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.

Tremor symptoms: how the disease manifests itself

• Physiological tremor- quick and easy tremor of the eyelids, fingers, head, which occurs during muscle activity, tension, cooling, overwork, emotional arousal.
• Senile (or senile) tremor- mixed trembling of the fingers, lower jaw, head, which does not significantly affect human movements.
• drug tremor- this type of tremor is caused by phosphodiesterase inhibitors (caffeine, aminophylline), glucocorticosteroids, β-adrenergic receptor agonists, lithium preparations, antipsychotics, valproate, tricyclic antidepressants, amiodarone, psychostimulants.
• Mercury tremor observed with mercury poisoning, occurs at rest, increases with voluntary muscle movements. Mercury tremor manifests itself in the muscles of the face, and then the limbs.
• Alcoholic tremor manifests itself in the form of trembling of the fingers of outstretched hands, which are divorced, as well as the muscles of the face, tongue. Alcohol tremor occurs with alcohol intoxication, alcoholism, withdrawal syndrome.
• hysterical tremor observed in hysteria, has a variable amplitude and rhythm, is constant or paroxysmal in nature, increases under the influence of psychological factors.
• Tremor with cerebellar injury is intentional and is manifested by rhythmic vibrations of the limbs as they approach the target (for example, when the hand touches the tip of the nose). Tremor can be postural in nature, occurring when maintaining a certain posture, holding gravity.
• Essential tremor can occur both when performing actions, and when maintaining a position, maintaining a posture. The tremor is bilateral, but may be asymmetrical. In addition to the limbs, the head (no-no or yes-yes type), lower jaw, legs, vocal cords may be involved. Intellectual abilities are preserved. In half of the cases, essential tremor is a hereditary disease with an autosomal dominant type of inheritance, although there is an opinion about the possibility of damage to the efferent pathways of the cerebellum.

Patient response to tremor

The appearance of tremor is the reason for going to the doctor and examination. It is necessary to determine the type of tremor, the causes of its development, as well as to carry out the necessary therapeutic measures to eliminate the problem and improve the quality of life of the patient.

Diagnosis of measles

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

• The “Rapid” method (film shooting) is a high frequency shooting followed by the 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, which is involved in the tremor. In the dark, the vibrations of the luminous elements are photographed on photographic film.
• Electromyography is a study of muscles that gives an idea of ​​the characteristics of rhythmic hyperkinesis.
• Other methods of research - are used at the discretion of the doctor, depending on the patient's state of health and the severity of pathological signs.

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

As for the severe tremor, which prevents the patient from living and working normally, in this case, potent drugs are used that relieve this problem. As a rule, these are beta-blockers, which, in sufficiently 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 antagonists, benzodiazepines (clonazepam), primidone are used. Tolerance can develop to the action of these drugs, so they are recommended to be used only when necessary.

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

Surgical methods are effective in the treatment of severe cerebellar tremor - stereotaxic thalamotomy, microstimulation of the thalamus. 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 zones responsible for the coordination of movements and tremor. This method of treatment 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 working capacity. In severe forms of tremor, it is difficult for the patient to even do basic things: eat or dress. In such cases, the patient can not do without outside help.

Tremor Prevention

Refusal of bad habits, as well as taking drugs that can cause tremors.

Tremor or trembling is a rhythmic movement that occurs with involuntary contraction, relaxation of the muscles.

How to find out if this is a pathology or a temporary manifestation of CNS disorders?

There are two types

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

Tremor of the extremities is rightfully considered the most common disorder of the human motor function. Tremors can be caused by poor genetics, but sometimes tremors appear as a result of a serious illness.

Causes of tremor

If you have trembling for more than 2 weeks, which does not depend on physical exertion and emotional experiences, then most likely this 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. Also, a concussion can cause tremors in the limbs. The trembling does not go away on its own.

There are the following types

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 the legs.

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

Some types of tremor are determined using laboratory tests, for example, in diseases of the thyroid gland.

Treatment of tremor of the limbs

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, taking sedatives and taking special baths are prescribed.

With pathological tremor

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

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

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

Alcohol can relieve trembling, but constant drinking is a sure way to alcoholism.

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

In especially severe cases, when a person is given a disability, surgery can help, in which the cerebellar region 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 to become a full-fledged member of society again, and not be a burden to their loved ones.