Benign Essential Tremor is the most common cause of hand tremors. However, whenever a person is seen to have hand tremors, the thought of Parkinson’s disease first comes to mind. Often, these tremors start making one withdraw socially. But not all hand tremors are due to Parkinson’s disease.
The Parkinson’s tremor is very typical and often accompanied by other characteristic features of Parkinson’s disease.
Read: Parkinson’s disease and tremor
NON-PARKINSON’S TREMORS
Even normally, tremors may be seen in the following situations:
- after exercise or sports
- stress, fear, anxiety
- exposure to cold,
- injury, lifting heavy things
- fever or infections
- on taking certain medicines
- alcohol intake or withdrawal, or too much caffeine.
These are usually temporary and should be ruled out as the cause of tremor by observation of daily lifestyle. Some of these factors can also bring on a benign essential tremor.
BENIGN ESSENTIAL TREMOR
The most common cause of tremor (more common than Parkinson’s), which often runs in families and is also seen usually past the age of 50, like Parkinson’s, is called benign essential tremor. The word ‘essential’ here relates to no evident cause, no other symptoms, or no other associated neurological problem being seen to exist with the tremor. ‘Benign’ means not harmful or life-threatening.
Tremor Characteristics
The characteristics of essential tremor are:
- Usually affects both sides together.
- The hands are the most commonly affected areas, but the head, neck, tongue, voice (quivering of voice), face (twitching), forearms, and even the trunk can show tremors.
- Tremors of the legs or feet are rare.
- Tremors are rapid, rather like a hand shiver, and not like the typical rolling tremor of Parkinson’s.
- Unlike the Parkinson’s tremor (seen at rest), the essential tremor is more of an action tremor and comes on usually when doing an activity like writing (handwriting can get distorted and bigger), tying or picking up something, and may very rarely occur at rest.
- Tremors may be brought on by emotional stress, fatigue, hunger, drastic temperatures, caffeinated drinks, and smoking.
Management
Usually, essential tremor doesn’t need treatment.
Some exercises of the hand may be done on a regular basis, like:
- Stress Ball Squeezes: Hold a stress ball or soft rubber ball in the palm. Squeeze as tightly as possible, hold for 10 seconds, and release. Repeat 10 times per hand.
- Finger Resistance: Place a thick rubber band around the outside of the fingers. Open the hand against the band’s resistance to stretch the fingers outward, then close them. Repeat 10 to 15 times.
There are also Apps available that help perform exercises like drawing patterns and hand-finger movements, which can help to strengthen the fingers and hand control.
If the tremor starts to significantly interfere with daily activities, some medicines like tranquilizers or those that reduce the activity of adrenaline may be prescribed along with the physical and lifestyle advice.
There are people who develop an essential tremor, but later also go on to develop Parkinson’s disease. So, it’s not as if the two are directly related, but they can, in some cases, occur in the same person.
OTHER CONDITIONS THAT CAN CAUSE TREMORS
Multiple Sclerosis
Multiple Sclerosis (MS) is a condition in which the protective sheath covering the nerves is lost; therefore, the nerves get inflamed and damaged. The tremor in MS can occur at rest, with activity, and even while lying down. MS has a younger age of onset compared to Parkinson’s and Essential tremor, though some of the symptoms may be similar between MS and Parkinson’s.
The differentiating features are the presence in MS of extreme fatigue, difficulty in walking, pain, touch-temperature sensitivity, dizziness, vision problems, and electric shock sensations on neck movements. The slowness of movement, stiffness, loss of facial expression, and the small, crawling handwriting are typical of Parkinson’s disease, not MS.
Thyroid disorder
Sometimes hyperactivity of the thyroid gland can produce a fine tremor along with other symptoms like weight loss, palpitations, nervousness, inability to sleep, irritability, tiredness, heat intolerance, and bulging eyes. The gland itself may be enlarged or swollen in the neck.
Others
Tremors may also be seen in chronic kidney disease or liver failure, a sudden drop in sugar, especially in people with diabetes, or after a brain injury or stroke.
So, running a few lab tests can help in eliminating other underlying medical problems and help to make a diagnosis more precisely when in doubt.
Also read:
Hyperkinetic Movement Disorders – Understanding 5 Types of Dyskinesia
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References:
National Institute of Ageing-NIH: Parkinson’s Disease
National Institute of Neurological Disorders and Stroke – Tremor fact sheet