Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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Essential Tremor is the most prevalent pathological tremor syndrome. It typically presents as a bilateral, largely symmetric postural and kinetic tremor. The classic symptom is shaking hands when holding a cup, using a spoon, or writing. Unlike Parkinson’s, the tremor is absent when the hands are resting in the lap.
The frequency is usually 4 to 12 Hz. It can affect the head (titubation), causing a “yes-yes” or “no-no” movement, and the voice. A distinct feature of ET is that it is often alcohol responsive; many patients report that a small amount of alcohol significantly reduces the shaking for a short period, likely due to CNS depression.
The classic Parkinsonian tremor is a “resting tremor.” It is asymmetric, often starting in one hand or foot. The movement is described as “pill rolling,” appearing as if the patient is rolling a small object between the thumb and index finger. It typically occurs at a frequency of 4 to 6 Hz.
A key diagnostic feature is “re-emergence.” When the patient lifts their hands, the tremor may stop briefly (as the muscles activate), but if they hold the posture for several seconds, the tremor re emerges. This distinguishes it from immediate postural tremor. Stress and cognitive load (like counting backward) often worsen the resting tremor.
Dystonic tremor occurs in a body part affected by dystonia—a condition causing abnormal twisting postures. This tremor is often “null point” dependent; there is a specific angle or position where the shaking stops. It is irregular in amplitude and frequency. Patients may use a “sensory trick” (geste antagoniste), such as lightly touching the chin, to stop the head from shaking.
Cerebellar tremor is the hallmark of ataxia. It is an intention tremor, meaning it has a low frequency (under 5 Hz) and high amplitude that dramatically increases as the limb approaches a target. It is often proximal, affecting the shoulders and trunk (titubation), leading to a chaotic, coarse shaking that makes eating or drinking nearly impossible.
Functional tremor is a common and complex disorder at the interface of neurology and psychiatry. It is characterized by distractibility and entrainment. If the patient is asked to tap a rhythm with their good hand, the tremor in the bad hand may stop or change its frequency to match the tapping (entrainment).
The onset is often abrupt, unlike the gradual progression of neurodegenerative tremors. The symptoms may be incongruent with known anatomical pathways. While the origin is not structural, the disability is real. It represents a disorder of voluntary motor control processing rather than a hardware failure.
Age is a significant risk factor for both Essential Tremor and Parkinson’s disease. However, ET has a bimodal distribution, with peaks in early adulthood and late life. Family history is a potent risk factor for ET; it is often inherited in an autosomal dominant pattern, though the specific genes remain elusive (familial tremor).
Many medications can induce or exacerbate tremor. Valproic acid (an antiepileptic), Lithium (a mood stabilizer), and bronchodilators (for asthma) are common culprits. Metabolic conditions such as hyperthyroidism, hypoglycemia, and liver failure (asterixis) also present with tremor like movements that must be ruled out.
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It is a specific hand movement seen in Parkinson’s disease where the thumb and index finger rub together in a rhythmic circular motion, resembling the rolling of a pill.
Alcohol acts as a central nervous system depressant that dampens the overactive electrical loops in the cerebellum that cause Essential Tremor, though the effect is temporary and rebound occurs.
Anxiety can cause a physiological tremor to become visible (enhanced physiological tremor), but it typically resolves when the anxiety is treated; it does not cause permanent neurodegeneration.
Asterixis is not a true tremor but a “negative myoclonus” or flapping tremor caused by the momentary loss of muscle tone, typically seen in liver or kidney failure.
No, isolated head shaking (titubation) is actually much more common in Essential Tremor or Dystonia; Parkinson’s tremor rarely affects the head alone, more often the jaw or chin.
essential tremor About 10 million people in the United States deal with uncontrollable shaking, often in their hands. This is called essential tremor. It makes
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