Tremor

A tremor is the uncontrolled shaking and trembling of one or more body parts. This is usually caused by a problem in the brain or the nervous system and can be a symptom of various conditions.

A tremor occurs most often in the hands but can also occur in other parts of the body, such as the head, the vocal cords, or the legs. Tremors vary in severity, from small tremors to more pronounced shaking.

Causes of tremors

There are different causes of tremors:

• Unknown cause. The essential tremor is the most common form of tremor and can occur at any age. The precise cause is unknown. There is often a hereditary predisposition, and it therefore also occurs in family members.
• Parkinson's disease. A key feature of Parkinson's disease is a shaking hand. The cause is a shortage of dopamine in the brain.
• Brain (cerebellar) damage. This tremor occurs due to damage to the cerebellum (the small brain) as a result of a stroke, tumour, or other neurological condition.
• Other diseases. For example, diabetes, multiple sclerosis (MS), or a metabolic disease.
• Poisoning. Some toxic substances cause tremors when ingested.
• Psychological cause. Some tremors arise due to psychological factors, such as stress or anxiety.
• Alcohol or medication. Excessive alcohol consumption or certain medicines can cause tremors.

Different types of tremor

In addition to different causes, different types of tremor can be distinguished. The most common types are:

• Resting tremor. This occurs when the body part is at rest and disappears with movement. It often occurs in Parkinson's disease and usually affects the hands, arms, legs, or chin.
• Action tremor. This arises when performing a goal-directed movement, such as writing, eating, or drinking. It often goes together with an essential tremor and usually affects the hands, arms, head, or vocal cords.
• Postural tremor. Taking or holding a certain posture, such as stretching the arms, is accompanied by shaking. The postural tremor often occurs in combination with an essential tremor and usually affects the hands, arms, or head. The tremor usually disappears when the body part is at rest.
• Intention tremor. This tremor occurs when approaching a goal, such as touching an object. It gets worse as one gets closer to the goal. It often occurs in MS and usually affects the hands, arms, or legs.
• Flapping tremor. With a flapping tremor, the hands and arms start to "flap" when they are stretched out. This tremor is the result of brain damage, a metabolic disease, or when the liver or kidneys fail.
• Orthostatic tremor. With this tremor, it is difficult to stand (remain) firmly. From the outside, this is not or hardly visible. The cause of this is unknown.

How does a tremor affect daily life?

The consequences of a tremor on daily life vary greatly from person to person. This depends, among other things, on the severity of the tremor, when it occurs, and what activities, work, and hobbies someone does in their daily life.

A tremor can cause difficulties with activities such as walking, cycling, eating, showering, brushing teeth, working on the computer, cooking, and social interactions. People with a (severe) tremor can also feel isolated and depressed due to shame or the inability to carry out activities.

Treatment of a tremor

Treatment depends on the type of tremor, its severity, and the underlying cause. In consultation with the GP or neurologist, the most suitable treatment is chosen. Examples include:

• Medication. For some types of tremor, medicines exist that reduce the complaints. Depending on the diagnosis, these are, for example, beta-blockers, dopamine enhancers, tranquillisers, or botox injections.
• Deep brain stimulation. This is an operation in which electrodes are placed in the brain to control the tremor. This method is often used in Parkinson's disease.
• Physiotherapy. Helps to improve muscle strength, coordination, and balance.
• Occupational therapy. Helps to adapt the living environment and to use aids for daily functioning.
• Good self-care. Better coping with stress, sufficient sleep, limiting alcohol and caffeine, stopping smoking, and relaxation techniques can help to reduce tremors. For this too, help from a specialist, such as a psychologist, may be needed.