Tremor

Overview

A tremor is an involuntary, rhythmic shaking, most often of the hands but sometimes the head, voice or legs. It is common and has several causes, most of which are benign. Identifying the type and any underlying cause guides management and, where needed, specialist referral.

Common types and causes

• Essential tremor — a common, often inherited tremor that worsens with action (holding a cup, writing) and improves with rest or a little alcohol; the most common type.
• Enhanced physiological tremor — a fine shake worsened by anxiety, caffeine, tiredness, low blood sugar or certain medicines (such as inhalers).
• Thyroid-related tremor — a fine tremor from an overactive thyroid; see Thyroid Disorders.
• Parkinsonian tremor — a resting tremor, often one-sided, with slowness and stiffness; needs neurological referral.
• Medication-induced tremor — from asthma inhalers, steroids, certain antidepressants or lithium.

Evaluation

Evaluation examines whether the tremor occurs at rest or with action, which parts are affected, and any family history. Blood tests check thyroid function, blood sugar and electrolytes, and a medication review is performed. A neurological examination looks for associated slowness, stiffness or balance changes that suggest Parkinsonism.

When to refer

• A resting tremor with slowness and stiffness — possible Parkinson’s disease.
• Tremor that is rapidly worsening or affecting one side only.
• Tremor with balance problems or falls.
• Tremor that is disabling despite initial treatment.

Management

Management depends on the cause: treating an overactive thyroid, reducing caffeine, adjusting medication, and using specific medicines for essential tremor when it interferes with daily activities. Parkinsonism is referred to a neurologist for specialist care. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

How we help

Dr. Nayak identifies the type and cause of tremor, treats reversible contributors such as thyroid dysfunction and medication, starts treatment for essential tremor when needed, and refers to a neurologist when Parkinsonism is suspected. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

• Thyroid Disorders
• Weakness
• Memory Problems
• Fatigue, Weakness & General Symptoms
• Abnormal Test Results