Tremor

Am Fam Physician. 2011;83(6):703-704

See related article on tremor.

What is a tremor?

A tremor is twitching or shaking of a body part that you can't control. Most tremors affect the hand, but they can also happen in the arm, head, leg, and even voice. They are more common in middle-aged and older adults, but they can happen at any age. Some tremors are barely noticeable, and some are more severe and may make it hard to write or hold things.

There are different types of tremors. A rest tremor happens when the body is relaxed. An action tremor happens while you are moving a part of your body. A postural tremor happens when your arm or leg is held against gravity (for example, holding your arms outstretched). A kinetic or intention tremor happens when you are trying to do a task (for example, drawing or pouring a drink). It is important for you to find out what type of tremor you have.

What causes it?

Anyone can have a tremor in certain situations. For example, you might have a tremor if you are very tired, nervous, drink caffeine, or are doing certain movements (for example, threading a needle). Most tremors happen in people who are otherwise healthy, but a tremor can sometimes be a sign of a health problem.

Certain medicines, including corticosteroids, amphetamines, and psychiatric drugs, can cause tremors. Anxiety and other psychological problems, an overactive thyroid, alcohol abuse or withdrawal, stroke or head injuries, and Wilson disease (a rare liver disease) can also cause tremors. Parkinson disease causes a resting tremor, and is most common in older adults. Some tremors run in families, and some have no known cause.

How do I find out what is causing it?

Your doctor will ask you about your tremor, your use of alcohol and medicines, and your family health history. He or she may examine you to assess your strength, sensory function (for example, sight, smell, touch), reflexes, and balance. Doctors can usually figure out what is causing your tremor by asking questions and examining you. Sometimes, a test for blood sugar level, kidney function, or liver function is needed. Rarely, a scan of your head may also be needed.

How is it treated?

Most tremors can't be cured, but they can be treated so they are less bothersome. The type of treatment depends on the cause of your tremor. Medicine may help with essential tremor, which is a tremor that sometimes runs in families and is worse when you move. Medicine may also help with tremors from Parkinson disease, thyroid problems, and Wilson disease. Your doctor may also suggest that you stop taking certain medicines or using other things that can trigger tremors (for example, alcohol, caffeine). Surgery is an option for severe tremors that don't respond to medicine. Some general treatments for all types of tremor include physical or occupational therapy, assistive devices (for example, utensils with large handles, button hooks, straws), and holding your arms close to the body.