Q: Some years ago in one of your columns you wrote about an ailment that may be due to emotional trauma. I had an experience in 1965 and have had shaking hands since. For example, I have problems putting a screwdriver in the slot of a screw, picking up and putting down a glass of liquid, and writing. And now, I tremble all over.
None of the doctors I have seen have an answer. I remember your column but not what you said. I’m now 72.
A: There are a number of medical issues that can cause a tremor – the muscle contraction and relaxation of one or more areas of the body. A tremor can affect the hands, arms, trunk, head, legs, face, eyes and vocal cords, with the most common area of the body being the hands.
Neurodegenerative disease, Parkinson’s, stroke, multiple sclerosis and numerous other conditions might be considered. Then there is always the excessive use of drugs such as corticosteroids, caffeine, amphetamines, cocaine, and alcohol. Hypoglycemia can cause tremors, as can stress, extreme fatigue, and a vitamin deficiency such as magnesium and thiamine which, by the way, will subside once the deficiency is corrected. A tremor can occur at any age; however, they are most common in the age group between 52 and 61. They may be temporary or occasional and affect men and women equally.
Let’s consider a few of the more common tremors. An intentional tremor may be caused by lesions in or damage to the cerebellum resulting from chronic alcoholism, overuse of specific medications, stroke, a tumor, an inherited degenerative disorder, or multiple sclerosis.
Benign essential tremor may be mild and non-progressive in some individuals, while in others it may progress slowly. It begins on one side of the body and will cross over to affect both sides within about three years. A gait abnormality may be observed. An exacerbation may be noted following stress, physical exhaustion, and low blood sugar levels. The onset of essential tremor generally begins after the age of 40.
A Parkinson’s tremor is often a precursor to Parkinson’s disease which is caused by damage to portions of the brain that control movement and a loss of dopamine. This tremor may affect the legs, trunk, chin and lips and can be exacerbated by stress or emotions. This tremor begins around the age of 60, begins in one of the extremities and commonly progresses to the opposite side.
An orthostatic tremor will reveal rhythmic muscle contractions that occur in the legs and trunk when an individual stands. The tremor will halt as soon as the individual sits back down or is lifted off the ground.
A rubral tremor presents as a slow tremor. It may be associated with conditions that affect the red nucleus in the center of the brain.
I don’t know how many physicians you have seen,or if you have had any testing performed but I urge you to make an appointment at a neurology clinic at a nearby teaching hospital where they can perform an extensive examination to determine if your tremors occur during rest or when you are active. Following a complete history and neurological examination, they may find your tremor may be inherited, your medications could be interacting, or the emotional trauma you experienced in 1965 may have some bearing that should be addressed. The specialists should recommend you have blood drawn which might determine abnormal vitamin/thyroid/chemical levels, and more. Your nerve function should be assessed.
Until the underlying cause for your tremors can be determined, they will likely continue. And while this may appear overwhelming, consider that an essential tremor may be controlled with an oral beta blocker; a Parkinson’s tremor may respond well to an oral dopamine-like drug; an orthostatic tremor may be treated successfully with Gabapentin or a combination of drugs; and so it goes. The bottom line is that you need a diagnosis which will then allow your physician(s) to help you. Don’t let things progress further. Call for an appointment today or ask your primary care physician for a referral.
