Tremor

Tremor Overview

Tremor is an involuntary, rhythmic, and oscillatory movement of a body part, typically caused by alternating or synchronous contractions of antagonistic muscles. It is the most common movement disorder, characterized by both resting and action tremors. The condition was first identified by James Parkinson in 1817, who described tremor as “involuntary tremulous motion in parts not in action” in his landmark essay on shaking palsy. Tremors can occur in isolation or as part of clinical syndromes such as Parkinson’s disease, essential tremor, and cerebellar disorders.

Types of Tremor

Resting Tremor

  • Occurs when the body part is at complete rest against gravity, decreasing during voluntary activity.
  • Commonly seen in conditions such as Parkinson’s disease and Parkinson’s-plus syndromes.
  • Examples include drug-induced parkinsonism and Wilson’s disease.

Postural Tremor

  • Occurs during the maintenance of a position against gravity and increases with action.
  • Commonly linked to essential tremor and metabolic disorders such as thyrotoxicosis.
  • Other causes include drug-induced tremors (e.g., lithium and amiodarone).

Kinetic (Action) Tremor

  • Present during voluntary movement.
  • Seen in conditions like essential tremor and cerebellar disorders.
  • Task-specific tremors like primary writing tremor fall under this category.

Intention (Terminal) Tremor

  • Increases during the terminal portion of targeted movement, often associated with cerebellar disorders.
  • Commonly linked to conditions such as multiple sclerosis and cerebellar strokes.

Causes of Tremor

Neurological Causes

  • Parkinson’s Disease
    • Resting tremor is characteristic.
    • Postural and kinetic tremors may develop later.
    • Caused by basal ganglia dysfunction.
  • Essential Tremor
    • Most common movement disorder.
    • Predominantly postural or action tremor with a family history of tremors in 60% of cases.
    • Often reduced by alcohol consumption.
  • Cerebellar Tremor
    • Associated with conditions like multiple sclerosis, stroke, and cerebellar injury.
    • Characterized by intention tremor with ataxia and dysmetria.
  • Holmes’ Tremor
    • Combination of resting, postural, and action tremors due to midbrain lesions (e.g., cerebrovascular accident, multiple sclerosis).
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Drug-Induced Tremor

  • Certain medications like neuroleptics, lithium, and amiodarone can induce tremors due to their effect on the extrapyramidal system.
  • Drugs like theophylline and valproate are less likely to cause parkinsonism.

Systemic and Environmental Causes

  1. Hyperthyroidism
    • Postural and action tremors commonly seen due to increased sympathetic activity.
  2. Alcohol Withdrawal
    • Essential tremor or high-frequency tremor.
  3. Chronic Liver Disease and Hepatic Failure
    • Tremor due to toxic accumulation of substances like ammonia.

Psychogenic Tremor

  • Can involve any body part, often sudden in onset.
  • Commonly includes postural, action, and resting components, often decreasing with distraction.

Symptoms of Tremor

Physiologic Tremor

  • Fine, low-amplitude tremor visible only under certain conditions (e.g., prolonged posture).
  • Usually normal neurological exam results.

Enhanced Physiologic Tremor

  • High-frequency, low-amplitude tremor that becomes visible under specific conditions such as drug or toxin exposure.
  • Symptoms usually improve after discontinuation of causative agents.

Essential Tremor

  • Predominantly postural and action tremor, often with a positive family history.
  • Alcohol may temporarily reduce tremor amplitude.
  • Associated with mild gait difficulties and hearing impairments.

Parkinson’s Tremor

  • Low-frequency resting tremor (pill-rolling tremor) with rigidity and bradykinesia.
  • No family history of tremor and alcohol doesn’t reduce symptoms.

Cerebellar Tremor

  • Intention tremor with ataxia, dysmetria, and dysarthria.
  • Associated with multiple sclerosis and stroke.

Holmes’ Tremor

  • Combination of rest, postural, and action tremors due to midbrain lesions.
  • Accompanied by signs of weakness and ataxia.

Diagnosis of Tremor

Clinical History

  • Important to detail tremor onset, duration, severity, and affected areas.
  • Assessing family history, alcohol influence, and associated symptoms like rigidity, bradykinesia, or hearing impairments is essential.

Clinical Examination

  • Tremor type (resting, postural, kinetic) and frequency should be noted.
  • The Findley rating scale helps categorize tremor severity:
    • No tremor
    • Slight tremor
    • Moderate tremor (<2 cm excursion)
    • Marked tremor (2 cm-4 cm excursion)
    • Severe tremor (>4 cm excursion)

Laboratory Workup

  • Thyroid function tests are crucial for ruling out hyperthyroidism.
  • In young patients, serum copper, ceruloplasmin, and 24-hour urinary copper are needed to exclude Wilson’s disease.
  • Brain imaging (MRI or CT) may be required for acute-onset tremors with cerebellar symptoms suggesting stroke or demyelinating diseases.

Differential Diagnosis

  • Myoclonus: Irregular, brief muscle jerks differentiable via electrophysiological analysis (EMG or EEG).
  • Clonus: Rhythmic movements around joints, differentiated by passive stretch.
  • Asterixis: Flapping tremor of extremities, diagnosable by irregular movements and longer pauses on EMG.

Epilepsia Partialis Continua: Rhythmic jerks associated with epilepsy, confirmed by EEG.

Comprehensive Care for Tremors at Buddhi Clinic

At Buddhi Clinic, we adopt a holistic approach to tremor treatment in Chennai, addressing the condition from all possible dimensions:

Accurate Diagnosis

Advanced diagnostic tools and thorough clinical evaluations ensure precise identification of tremor types and their underlying causes.

Personalized Treatment Plans

Pharmacological interventions, including beta-blockers, anticonvulsants, and dopamine agonists, are tailored to the patient’s condition.

  • Non-invasive therapies like Botox injections for focal tremors.

Physical and Occupational Therapy

Motor skill rehabilitation and adaptive strategies to enhance functionality and independence.

Lifestyle and Stress Management

Guidance on reducing triggers like caffeine and stress, alongside mindfulness techniques.

Advanced Interventions

Deep Brain Stimulation (DBS): A surgical option for severe, medication-resistant tremors.

Why Choose Buddhi Clinic for Tremor Treatment in Chennai?

Buddhi Clinic is a trusted provider of tremor treatment in Chennai, known for its comprehensive and patient-focused approach. Our clinic offers advanced diagnostic capabilities, including state-of-the-art neuroimaging, electromyography (EMG), and laboratory testing to ensure accurate and reliable assessments. With a multidisciplinary team comprising neurologists, psychologists, therapists, and rehabilitation specialists, we deliver expert care from various perspectives. The clinic emphasizes a holistic approach, addressing not only the physical symptoms of tremors but also the emotional, psychological, and social challenges faced by patients. By developing personalized care plans, Buddhi Clinic prioritizes enhancing quality of life, functionality, and overall well-being, ensuring every patient receives tailored, compassionate care.

Contact Us

For specialized tremor treatment in Chennai, schedule a consultation with Buddhi Clinic. Our expert team is here to guide you every step of the way, ensuring you receive the best possible care tailored to your needs.

Our Buddhi Clinic Centres

Chennai Teynampet, Sriperumbudur, Coimbatore

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Chennai - OMR, Indore

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