Tremor and Parkinson’s: A Primer

Close up of physician's hand holding patient's hand to diagnosis tremor

Even though other health conditions can cause shaking hands and feet, approximately 70% of people with Parkinson’s experience tremor. A tremor is an involuntary, rhythmic shaking or quivering movement which can occur in the hand, arm, foot, leg, and chin, with the most common being in a person’s hands.

Tremors can cause complications with many activities of daily living that involve fine motor skills, such as brushing teeth, shaving, bathing, getting dressed, writing a letter, and eating. If you have a tremor, activities can also take longer to accomplish than they once did. The good news is that although a tremor is bothersome and can be embarrassing, it is not incapacitating or life-threatening. In addition, there are many actions you can take to manage this symptom. In this post, we’ll take a look at the causes of tremor, types of tremor, and strategies to manage it so you can live well with Parkinson’s.

What causes tremor in Parkinson’s?

Imbalances in neurotransmitters cause tremors. As dopamine cells disappear because of Parkinson’s, a neurotransmitter called acetylcholine becomes over-expressed, and this excess results in involuntary shaking movements. In the early stages of Parkinson’s, tremor is typically seen on one side of the body, often starting in a hand; however, as Parkinson’s progresses, tremor may impact both sides and affect more body regions. The patterns, forms, and progression of tremors are individual to each person.

TYPES OF TREMOR

There are many different types of tremor. Here, we’ll discuss those that are most common for people living with Parkinson’s.

Pill-Rolling Tremor

This type of tremor, often one of the first symptoms of Parkinson’s, occurs in the fingers. Finger twitching is a movement that looks like a person is rolling a pill between their thumb and fingers. In medical jargon, it is fittingly defined as a “pill-rolling” tremor.

Resting Tremor

The most common tremor in Parkinson’s is the resting tremor, which occurs when a person is at rest or (paradoxically) under emotional or physical stress. When the affected part of the body is actively moving, resting tremors often subside. For example, when a person holds a spoon while eating, the thumb and index finger muscles are held in one position, and a resting tremor can transpire; consequently, the food on the spoon may spill. The resting tremor lessens when the muscle is in action. For example, if a person’s hand is shaking while sitting, once that person moves the hand to shake hands with someone, the shaking will often disappear. Similarly, resting tremor in the legs occurs when a person is lying down or sleeping or when one’s feet are dangling. Again, if one starts moving, the tremor disappears.

Middle eastern businessman shake hands with businesswomanAction Tremor

An action tremor, of which essential tremor is a type, is the shaking motion that occurs when a limb or body part is being moved. While action tremors are much less common in people with Parkinson’s, more than 25% of people with Parkinson’s do experience them.

Internal Tremor

Even though others cannot see an internal tremor, many people with Parkinson’s report a shaking sensation inside the chest, abdomen, or limbs. Because this internal tremor is difficult to explain to others and is often upsetting to the person with Parkinson’s, it can distract and interrupt the flow of what they’re doing. While internal tremors can be extremely difficult to identify and describe, they often respond to medications in a similar way that external tremors do.

How Is Tremor Diagnosed?

Doctors often diagnose tremors through physical and neurological examinations and a medical history review. During the physical evaluation, a doctor will assess the tremor to see if it occurs when your muscles are at rest or in action, where they are located on your body, if they occur on one or both sides, and their frequency and amplitude. They will also assess other neurological functions such as walking, balance, speech, muscle tone, and mobility.

STRATEGIES TO MANAGE TREMORS

Medications

Routine. Routine. Routine. It is critical to take your medications consistently and on time, even if you don’t currently feel a tremor. Having a constant medication level in your body by following your physician’s medication schedule can help prevent OFF times. OFF times are when your medications aren’t working optimally, and your tremor returns or worsens. Create a habit of taking your medications at the same time each day and of taking your carbidopa/levodopa on an empty stomach with a full glass of water. Drinking a full glass of water when taking your pills helps flush the medicine quickly from your stomach to your small intestines, where it is absorbed. If you need help with medication management, talk with your physicians about wearable technologies that can help monitor movement fluctuations and determine proper medication dosages.

Medications and glass of waterAs the most common medication used to control movement symptoms of Parkinson’s, carbidopa/levodopa typically helps relieve tremors in people with Parkinson’s. Other medications, such as anticholinergics, are sometimes used to control tremors, but because these can cause significant mental and physical side effects, be sure to discuss all options with your doctor carefully. Propranolol, a drug used for hypertension, heart disease, and migraine headaches, is occasionally helpful for managing parkinsonian tremors, as is Clozapine, a drug used for treating schizophrenia. Although it may be effective for controlling tremor, Clozapine requires those taking it to adhere to strict monitoring of blood work for the first year and a half of use.

Exercise

Exercise can help manage many motor symptoms of Parkinson’s, including tremor. While studies show regular exercise can improve heart health, increase strength, improve endurance, reduce fatigue, and positively impact mood and self-esteem in all people, research studies have found that people with Parkinson’s who participated in high-intensity exercise experienced noticeable improvement in their overall movement and reduced tremor after exercising. (Also, individuals with Parkinson’s who exercised more often required less additional medication and had the slowest rate of change over a year.)

Female walking with Nordic polesOf course, talk to your physician before starting any exercise program, but once you receive the go-ahead, find a form of movement that brings you joy. Whatever movement activity brings a smile to your face will help manage the motor symptoms of Parkinson’s, including tremor.

Reduce Multi-Tasking

Doing just one thing at a time can lessen tremors. For example, when eating, place your elbows on the table to stabilize your arms. Sit down when you brush your teeth, so you only need to focus on your upper body muscles. Hold your arms as close to your body as possible when writing a check. When you walk, keep your hands and arms free.

Reduce Stress

Not completing tasks as efficiently as you could before you experienced tremor can be disheartening, stressful, and fatiguing. The next time you feel frustrated while trying to accomplish a task, take a few deep breaths to help rebalance your nervous system and allow your muscles to relax. Then, try the action again.

Consider Assistive Technologies and Products

To help you everywhere—from the kitchen to the bathroom, bedroom, golf course, swimming pool, sidewalk, and more—there are tools, gadgets, and equipment designed especially for people who experience tremor, and new ones are invented all the time. Whether it’s stretchy elastic shoelaces or a long-handled shoehorn to help you put on socks and shoes, an adaptive mouse for computer work, weighted silverware to help decrease tremor while eating, or Velcro buttons, a wide variety of devices can help you feel safe, become more confident when attempting various tasks, gain more independence, and increase self-efficacy.

Cheerful little boy and grandfather having a healthy breakfast while sitting in the kitchenYou can begin managing your tremors today by practicing all the tips we just shared. The key is to take action now. The more you do today, the more vital, more mobile, and happier you will be while living with Parkinson’s.

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