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 | Tremor
By Michael Spilane, MD
A slight hand tremor or shake does not alarm anyone if it can be blamed on anxiety, too much coffee, or over-indulgence in alcohol. Worry begins when a tremor persists without a clear reason. The likelihood of hand tremor increases with advancing age about 20 percent of people age 80 and over are afflicted.
The most common type of tremor is termed essential. Physicians call a symptom or ailment essential when they do not understand the cause and when it exists by itself without other associated troubles. Essential tremor has also been called benign tremor, familial tremor, and senile tremor. Essential is the preferred term--the shakiness is not benign (or harmless) to the person who suffers with it, does not always run in a family, and can begin at younger age.
Essential tremor is characterized by a rapid (6 to 8 movements per second) shake that is exaggerated by certain positions of the arms. It may decrease with initiation of voluntary movement, only to worsen as the hand reaches its destination. And it often subsides, or even disappears, with total rest of the arm and hand. The tremor most often begins in the sixth or seventh decade, but can present much earlier. Though it may progress in severity, more often it remains unchanged for many years. The shaking is usually mild and a nuisance, but it can be severe and incapacitating. It is made worse by fatigue, stress and caffeine. Almost all that have the tremor discover that modest amounts of alcohol dramatically reduce the movements.
A person with essential tremor carries not only the burden of spilled coffee, but also the fear of social rejection. The worry of being noticed in public and considered senile can lead to isolation and mood disorder. Self-confidence is essential for those with an essential tremor and it begins with understanding that the shake is not associated with other health problems. And that it has nothing to do with loss of mental faculties.
Essential tremor is generally resistant to medical interventions, but beta-blocking drugs such as Propanolol and Metoprolol may help to some degree. Doctors urge their patients not to rely on alcohol for symptomatic relief--the tremor will in fact worsen once the effect of the liquor has worn off.
Unlike essential tremor, the shake of Parkinsons Disease is associated with other problems. The tremor is just one part of a much larger symptom complex, and the troubles tend to be progressive. Parkinsons Disease almost always involves generalized rigidity of body muscles, slowing of gait, imbalance, and a reduction of spontaneous gestures and facial expressions. The tremor is very noticeable in most, but is absent is some. It is coarse and slow (about 4 movements per second) compared to the finer and quicker shake of essential tremor, and it is more pronounced with rest of the arms and hands than with movement.
Disease of certain movement control centers of the brain can result in incoordination and abnormal movements of the arms and hands. Victims poke and jerk, but they do not actually have a tremor. Arm and hand movements are imprecise but not rapid and repetitive. No movement abnormality is noticed when the arms are at rest. The problem is called ataxia and can be caused by stroke, hereditary conditions, toxins, and alcoholism.
If you have a tremor or shake, it is best to seek advice from your physician. If you are told that you have essential tremor, be reassured that it will not affect your general health. Openly discussing the matter with family and friends is a good way to begin building self-confidence and to avoid psychological consequences of the problem.
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