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Tremors not always caused by Parkinson’s

By Kathy Hubbard

While researching Parkinson’s Awareness Month, I came across a question posted on Providence Health Services website that took me down a bunny trail. The patient asked, “Is the shaking in my left hand, which was diagnosed as an essential tremor related to Parkinson’s disease?”

Dr. Kiren Kresa-Reahl, a neurologist with Providence, replied. “There’s a common misconception that everything that shakes is Parkinson’s disease, but that’s not true. Both essential tremor and Parkinson’s cause hand tremors, but they are completely different disorders. Having an essential tremor does not mean that you have or will get Parkinson’s disease.

Following that line of thinking, not all people with Parkinson’s have a tremor, either. So that led me to follow the rabbit and to start treading about tremors and what possibly could be the cause and certainly the effect.

Tremors are classified into two main categories, resting, and action. The resting tremor is most often seen in people with Parkinson’s. It occurs when the muscle is relaxed. An action tremor occurs with the voluntary movement of a muscle.

The National Institute of Neurological Disorders and Stroke drills the description of action tremors down to more classifications, many of which overlap. “Postural tremor occurs when a person maintains a position against gravity, such as hold the arms outstretched. Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.

“Intention tremor is produced with a purposeful movement toward a target, such as lifting a finger to touch the nose. Task-specific tremor only appears when performing highly skilled, goal-oriented tasks such as handwriting or speaking. Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement such as holding a heavy book in the same position.”

There are more than twenty types of tremors. The most common is the essential tremor. The cause is unknown, and although it can occur at any age, it most often starts in people aged forty and older. Typically, it isn’t a dangerous condition, but it can worsen over time.

“About half of essential tremor cases appear to result from a genetic mutation,” Mayo Clinic says. “This form is referred to as familial tremor. It isn’t clear what causes essential tremor in people without a known genetic mutation.”

Symptoms begin gradually and are usually more prominent on one side of the body. They will worsen with movement. The tremors typically occur in the hands first and include a “yes-yes” or “no-no” motion of the head. Symptoms can be aggravated by emotional stress, fatigue, caffeine, or temperature extremes.

The other types of tremors include dystonic, cerebellar, psychogenic, physiologic, Parkinsonian, and orthostatic. The NINDS website gives a detailed description of each if you’re interested in learning more.

Diagnosis of the cause of tremor will include blood and urine tests to determine whether the patient has thyroid disease or metabolic problems, whether the tremor results from a drug side effect, and levels of chemicals that may cause the tremor.

The patient will also undergo a neurological examination to test the nervous system, including tendon reflexes; muscle strength and tone, feeling certain sensations, posture and coordination, and gait.

“Although many cases of tremor are mild, tremor can be very disabling for other people,” NINDS says. “It can be difficult for individuals with tremors to perform normal daily activities such as working, bathing, dressing, and eating. Tremor can also cause ‘social disability.’ People may limit their physical activity, travel and social engagements to avoid embarrassment or other consequences.”

Dr. Kresa-Rehl says that some medications that may ease tremor symptoms have side effects that need to be considered. Some of the side effects may be harder to live with than the tremors themselves. In some significant cases, surgery is an option.

As for lifestyle, Dr. Kresa-Rehl suggests reducing stress, getting plenty of sleep, cutting out caffeine, and maintaining your sense of humor. Although it may reduce symptoms, do not self-medicate with alcohol.

“Although the tremor may get a little worse over decades of your life, it’s not fatal, it won’t cripple the rest of your body, and it doesn’t have to cripple your life,” she says.

Kathy Hubbard is a member of the Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com.

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