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Tremors are involuntary and uncontrollable rhythmic movements of a body part. They are usually classified as either resting tremors or action tremors. Resting tremors occur when the body is at rest, while action tremors occur during the movement of the affected body part. Tremors can be caused by a variety of factors, including neurological disorders, anxiety, strenuous exercise, and substance use. While most tremors are not life-threatening, they can cause significant challenges in daily life and may even lead to disabilities. Understanding the underlying causes of tremors is crucial for developing effective treatments and improving the quality of life for individuals experiencing these involuntary movements.
| Characteristics | Values |
|---|---|
| Definition | Unintentional and uncontrollable rhythmic movements of one limb or part of the body |
| Types | Resting tremors, action tremors, postural tremors, intention tremors, isometric tremors, orthostatic tremors, Parkinsonian tremors, functional tremors, dystonic tremors, cerebellar tremors, essential tremors |
| Causes | Strenuous exercise, anxiety, hyperstimulation, stress, strong emotion, physical tiredness, certain postures or movements, neurologic disorders, Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury, certain medications, poisoning from toxic substances, alcohol use disorder, overuse of certain medications, caffeine, age, genetics |
| Treatment | Eliminating or reducing substance use, using assistive tools, wearing adaptive clothing, taking medications, reducing stress, getting enough quality sleep, joining a support group, physical therapy, speech-language therapy, occupational therapy, Botox injections, surgery |
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Muscle fatigue
Muscle tremors can be caused by a variety of factors, including lifestyle choices, medical conditions, and psychological conditions. For instance, tremors can be caused by consuming too much caffeine, or they can be a symptom of a more serious medical condition, such as Parkinson's disease, stroke, or low blood sugar. Tremors can also be caused by psychological conditions such as anxiety disorder, which can cause muscles to shake, vibrate, jitter, or tremor during anxiety or panic attacks.
When a muscle is electrically excited and contracts, not all motor units are excited simultaneously. Instead, they are excited in an asynchronous fashion by electrical impulses from the motor nerves in the spinal cord. As a result, some motor units are contracting and shortening, while others are relaxing and lengthening, creating an overlap that gives the appearance of a smooth overall contraction. However, strenuous exercise can cause some motor units to drop out of service due to fatigue. This fatigue likely occurs within the spinal cord, specifically within the motor nerve cell and its neural connections, as well as at the connections between the motor nerve and its muscle cells (the myoneural junction).
As more motor units become fatigued and nonfunctional, the muscle contraction becomes dependent on a smaller number of motor units. This leads to more synchronous and less smoothly organized contractions and relaxations. Consequently, the smooth contraction observed previously is replaced by a jerky, trembling movement. Adequate rest is essential to alleviate muscle fatigue, as it allows the fatigued motor units to recover and return to normal functioning, restoring smooth contractile motion in the muscle.
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Dystonic tremors
Dystonia causes muscles to spasm and contract involuntarily, resulting in twisting and repetitive motions or abnormal postures, such as twisting of the neck. The muscle contractions can be voluntary or involuntary. In the case of the latter, rhythmic and irregular bursts of electromyographic (EMG) activity at 1-6.5 Hz have been observed.
There are two forms of tremor in dystonia: dystonic tremor, produced by dystonic muscle contraction, and tremor associated with dystonia, which is a tremor in a body part that is not dystonic, but where there is dystonia elsewhere. Both forms often resemble essential tremor or another pure tremor syndrome, such as isolated head and voice tremors.
Dystonic tremor is often suppressed by sensory tricks and may exhibit null points (body positions with no tremor), irregular jerky rhythm and amplitude, task or position specificity, persistence at rest, and overflow to neighbouring body segments. However, there is currently no definitive diagnostic test for distinguishing dystonic tremor from essential tremor.
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Orthostatic tremors
Orthostatic tremor is a rare movement disorder that causes rapid muscle contractions (tremors) in the legs when standing. This condition was first described in 1984 and is considered progressive, with the tremors becoming more severe over time. The main symptom is a feeling of unsteadiness or imbalance while standing, which disappears when walking, sitting, or lying down. The tremors are typically not painful, but leg muscle pain may develop over time. While the exact cause of orthostatic tremor is unknown, researchers are investigating potential genetic factors, as some cases have been found to affect biological family members. Orthostatic tremor can significantly impact an individual's quality of life, and while there is no known cure, certain medications, such as Clonazepam, Pregabalin, or Lyrica, can help ease the symptoms. Mobility aids, such as wheelchairs or scooters, may also be necessary for some individuals to maintain their independence.
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Anxiety
The experience of anxiety and the associated tremors can vary from person to person. Some people may experience tremors only when moving certain muscles, while others may have constant tremors or experience them in episodes. The intensity of the tremors can also range from mild to severe and may come in waves, easing off at times and returning at others.
It is important to note that while anxiety can cause muscle tremors, it is not the root cause of all tremors. Other factors, such as essential tremor, Parkinson's disease, stroke, or injury, can also contribute to tremors. Additionally, feelings of anxiety may develop as a result of living with a movement disorder like essential tremor, especially in social situations where the tremors are more apparent.
To manage anxiety-induced tremors, individuals can employ various strategies to reduce stress and guide their bodies back to a relaxed state. This includes stress reduction techniques, progressive muscle relaxation, deep breathing exercises, mindfulness meditation, yoga poses, and distraction activities. Seeking professional help from a licensed therapist or psychiatrist is also recommended for long-term management of anxiety and its associated symptoms.
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Parkinson's disease
Tremors are an early and common symptom of Parkinson's disease, typically starting on one side of the body and progressing to the other side as the disease advances. The tremors usually affect the hands, fingers, jaw, and feet, and they tend to be more forceful with lower frequency. They occur mostly at rest and lessen during sleep or when the affected body part is in use, such as when shaking hands. For example, a person with Parkinson's disease may spill things due to the tremor when bringing a spoon or fork to their mouth.
Treatments for Parkinson's disease tremors include medications and, if those are ineffective, surgical interventions such as deep brain stimulation (DBS) and focused ultrasound (FUS). While these treatments can help control the tremors, there is currently no cure for Parkinson's disease, and the symptoms tend to worsen over time.
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Frequently asked questions
Strenuous exercise can cause some motor units to drop out of service due to fatigue, resulting in tremors. These motor units are part of the nervous system and are responsible for contracting and relaxing muscles. When some motor units stop functioning due to exhaustion, the remaining units contract and relax more synchronously, resulting in a jerky, trembling movement.
There are various types of tremors, including resting tremors, action tremors, orthostatic tremors, Parkinsonian tremors, functional tremors, isometric tremors, and dystonic tremors. Resting tremors occur when you're sitting or lying still, while action tremors happen during movement. Orthostatic tremors involve rapid muscle contractions in the legs when standing, and they usually stop when sitting or walking. Parkinsonian tremors are often an early sign of Parkinson's disease. Functional tremors can take any form and are often associated with psychiatric conditions. Isometric tremors occur during voluntary muscle contractions without movement, like making a fist. Dystonic tremors are caused by dystonia, a movement disorder characterised by involuntary muscle contractions leading to twisting and repetitive movements.
While there is no cure for most forms of tremors, treatments are available to help manage symptoms. Reducing or eliminating substance use, such as caffeine or alcohol, can help if these substances worsen the tremors. Using assistive tools, adaptive clothing, and taking medications as directed can also make daily tasks more manageable. Additionally, physical, speech-language, and occupational therapy can aid in controlling tremors and improving daily functioning.
