What Is Tremor?

Tremor is an unintentional, somewhat rhythmic, muscle movement involving to-and-fro movements of one or more parts of the body. Most tremors occur in the hands, although they also can affect the arms, head, face, vocal cords, trunk and legs. Sometimes tremor is a symptom of another neurological disorder, but the most common form occurs in otherwise healthy people. Some forms of tremor are inherited and run in families, while others have no known cause. Excessive alcohol consumption or alcohol withdrawal can kill certain nerve cells, resulting in tremor, especially in the hand. Other causes include an overactive thyroid and the use of certain drugs. Tremor may occur at any age but is most common in middle-aged and older persons.

Essential tremor (sometimes called benign essential tremor) is the most common of the more than 20 types of tremor. The hands are most often affected but the head, voice, tongue, legs and trunk also may be involved. Head tremor may be seen as a "yes-yes" or "no-no" motion. Onset is most common after age 40, although symptoms can appear at any age. Parkinsonian tremor is caused by damage to structures within the brain that control movement. The tremor is classically seen as a "pill-rolling" action of the hands but also may affect the chin, lips, legs, and trunk. Dystonic tremor occurs in individuals of all ages who are affected by dystonia, a movement disorder in which sustained involuntary muscle contractions cause twisting motions or painful postures or positions.

Is There Any Treatment?

There is no cure for most tremors. The appropriate treatment depends on accurate diagnosis of the cause. Drug treatment for parkinsonian tremor involves levodopa or dopamine-like drugs such as pergolide mesylate, bromocriptine mesylate and ropinirole. Essential tremor may be treated with propranolol or other beta blockers (such as nadolol) and primidone, an anticonvulsant drug. Dystonic tremor may respond to clonazepam, anticholinergic drugs, and intramuscular injections of botulinum toxin. Eliminating tremor "triggers" such as caffeine and other stimulants from the diet is often recommended. Physical therapy may help to reduce tremor and improve coordination and muscle control for some patients. Surgical intervention, such as thalamotomy and deep brain stimulation, are usually performed only when the tremor is severe and does not respond to drugs.

What Is the Prognosis?

Although tremor is not life-threatening, it can be embarrassing to some people and make it harder to perform daily tasks.

Additional Resources

International Essential Tremor Foundation
P.O. Box 14005
Lenexa, KS 66285-4005
1-888-387-3667 or (913) 341-3880
Fax: (913) 341-1296
Internet: www.essentialtremor.org
E-mail: staff@essentialtremor.org

WE MOVE (Worldwide Education & Awareness for Movement Disorders)
204 W. 84th St.
New York, NY 10024
1-866-546-3136 or (202) 875-8312
Fax: (202) 875-8389
Internet: www.wemove.org
E-mail: wemove@wemove.org

Tremor Action Network
P.O. Box 5013
Pleasanton, CA 94566-5013
(510) 681-6565 or (925) 462-0111
Fax: (925 369-0485
Internet: www.tremoraction.org
E-mail: tremor@tremoraction.org

National Ataxia Foundation (NAF)
2600 Fernbrook Lane North, Suite 119
Minneapolis, MN 55447-4752
(763) 553-0020
Fax: (763) 553-0167
Internet: www.ataxia.org
E-mail: naf@ataxia.org

Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health

Updated: March 19, 2007

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