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    Tremor

    Tremor - hand; Hand tremor; Tremor - arms; Kinetic tremor; Intention tremor; Postural tremor

    A tremor is a type of shaking movement. A tremor is most often noticed in your hands and arms. It may affect any body part, even your head or voicebox.

    Considerations

    Tremors can happen at any age. They aremore common in older people. Everyone has some tremor when they move their hands. Stress, fatigue, anger, fear, caffeine, and smoking may make this type of tremor worse.

    A tremor that does not go away over time may be a sign of a medical problem and should be checked by your health care provider.

    Essential tremoris the most common tremor. The shaking most often involves small, rapid movements. It usually occurs when you are trying to do something, such as reaching for an object or writing. This type of tremor may also run in families.

    Causes

    Tremor may be caused by:

    • Certain medicines
    • Brain, nerve, or movement disorders, including uncontrolled miscle movements (dystonia)
    • Brain tumor
    • Excessive alcohol consumption, alcoholism, or alcohol withdrawal
    • Multiple sclerosis
    • Muscle tiredness or weakness
    • Normal aging
    • Overactive thyroid
    • Parkinson disease
    • Stress, anxiety, or fatigue can cause a postural tremor
    • Stroke
    • Too much coffee or other caffeinated drink

    Home Care

    For tremors caused by stress, try ways to relax such as meditation or breathing exercises. For tremors of any cause, avoid caffeine and get enough sleep.

    For tremors caused by a mdicine, talk to your doctor about stopping the drug, reducing the dosage, or switching to another medicine. Do not change or stop medications on your own.

    For tremors caused by alcohol abuse, seek treatment to help you stopalcohol.

    Severe tremors may make it hard to do daily activities. You may need help with these activities.

    Devices that may help include:

    • Buying clothes with Velcro fasteners or using button hooks
    • Cooking or eating with utensils that have a larger handle
    • Using a sippy cup to drink
    • Wearing slip-on shoes and using shoehorns

    When to Contact a Medical Professional

    Call your doctor if your tremor:

    • Is worse at rest and gets better with movement such aswhen you reach for something.
    • Is prolonged, severe, or interferes with your life.
    • Occurs with other symptoms, such as headache, weakness, abnormal tongue movements, muscle tightening, or other movements that you cannot control.

    What to Expect at Your Office Visit

    Your doctor will perform a physical exam, including a detailed brain and nervous system (neurologic) examination. You may be asked questions to help your doctor find the cause of your tremors:

    The following tests may be ordered:

    • Blood tests such as CBC, blood differential, thyroid function tests, and glucose test
    • EMG or nerve conduction studies
    • Head CT scan
    • MRI of the head
    • Urine tests

    Once a cause of the tremor has been determined, treatment will be prescribed.

    You may not need treatment unless the tremor interferes with your daily activities or causes embarrassment.

    Treatment depends on the cause. Tremor caused by a medical condition, such as hyperthyroidism, will likely get better when the condition is treated.

    If the tremor is caused by a certain medicine, stopping the drug will usually help it go away. Never stop taking any medicine without first talking to your doctor.

    You may be prescribed medicines to help relieve symptoms. How well medicines work depends on your overall health and the cause of the tremor.

    References

    Deuschl G. New hope for severe essential tremor? Lancet Neurol. 2013:12:420-422.

    Jankovic J. Movement disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 71.

    Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 417.

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        Review Date: 5/28/2013

        Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network. Also reviewed David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.

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