Tremor

Tremor is an involuntary, rhythmic shaking of a body part, most often the hands, but also the head, voice or legs. It is a symptom, not a diagnosis. The commonest causes are essential tremor, Parkinson's disease, medication side effects and an exaggerated normal tremor from anxiety, caffeine or an overactive thyroid.

When the tremor appears is the main clue: at rest suggests Parkinson's disease, while shaking during holding or moving suggests essential tremor. Most tremors can be reduced, though seldom abolished, with medication, and severe cases have effective surgical options.

Symptoms

• Shaking of the hands when holding a cup, writing or using cutlery
• Shaking of a resting hand that settles with movement
• Nodding or side-to-side head movement
• Quavering voice
• Worsening with stress, fatigue or caffeine
• Temporary improvement after a small amount of alcohol, typical of essential tremor

Causes and risk factors

Essential tremor affects about 1 in 100 people, more with age, and runs in families in around half of cases. Parkinsonian tremor comes from loss of dopamine cells. Drugs that cause tremor include salbutamol, valproate, lithium, some antidepressants, amiodarone and ciclosporin. Other causes are thyroid overactivity, dystonia, cerebellar disease from MS or stroke, neuropathy, alcohol withdrawal, functional tremor and, in younger people, Wilson's disease.

How it is diagnosed

• Clinical examination: Observation at rest, with arms outstretched, on finger-to-nose testing, and while writing and drawing spirals.
• Blood tests: Thyroid function; copper studies under the age of 50.
• DaT scan: Separates parkinsonian from essential or drug-induced tremor when examination is inconclusive.
• MRI brain: When signs suggest a structural or cerebellar cause.
• Tremor recording: Surface EMG and accelerometry measure frequency and help identify functional tremor.

Treatment options

• Remove triggers: Review medication, cut caffeine and treat thyroid disease.
• Propranolol or primidone: First-line drugs for essential tremor, each helping about half of patients.
• Topiramate or gabapentin: Second-line choices.
• Botulinum toxin: Useful for head and voice tremor.
• Deep brain stimulation: Thalamic stimulation for disabling tremor; adjustable and can treat both sides.
• MRI-guided focused ultrasound: An incisionless lesion in the thalamus for one side, done in a single session.

When it is urgent

Tremor appearing suddenly with weakness, speech difficulty, confusion or fever, or after a new drug or an overdose, needs urgent local assessment. A slowly developing tremor is not an emergency.

Travelling to Türkiye for treatment

A visit can clarify the diagnosis with a specialist examination and DaT scan in 2 to 3 days. Focused ultrasound or DBS for medication-resistant tremor are planned procedures that suit travel, provided DBS programming is secured at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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