Tremors: they are a type of involuntary shaking movement.
Types of tremor include:
1- Drug-induced tremor
2- Essential tremor.
3- Familial tremor.
There are three main types of tremors:
1- Resting (or static) tremors: These tremor are present when the muscle are resting. The
tremor may go away or become less noticeable when it moves muscles that are
involved.
2- Intention (or kinetic): These tremors occur at the end of a purposeful (intended) movement
such as writing, pressing a button, or reaching for an object. The tremor will usually
disappear while the affected body part is at rest.
3- Postural or action tremors occur when are holding the arm or leg in one position for
a period of lime against gravity, This may happen when are writing, holding a cup,
holding the arms out, or when the stand up straight.
Causes:
1- Tremors are caused by problems with the nerves supplying certain muscles. They
may affect the whole body or just certain areas, as with hand tremor.
2- Alcohol withdrawal.
3- Cigarette smoking.
4- Hyperthyroidism.
5- Parkinson's disease.
6- Pheochromocytoma.
7- Too much caffeine.
8- Use of certain medications.
9- Wilson's disease.
All people have some tremor when they move their hands. Stress, fatigue, anger, fear, caffeine,
and cigarettes may temporarily worsen this type of tremor.
Symptoms:
Tremors may affect the hands, arms, head, eyelids, voice box, or other muscles .
The shaking usually involves small, rapid movements more than 5 times a second.
The tremors may:
- Occur when it moves (action-related tremor), and may be less noticeable with rest.
- Come and go, but generally get worse with age.
- Disappear with sleep.
- Get worse with stress, caffeine, and certain medications.
- Not affect both sides of the body the same way.
- Head nodding may be a symptom of a tremor.
- If the tremor affects the voice box, it has a shaking or quivering sound to voice.
Treatment
Treatment may not be necessary unless the tremors interfere with their daily activities or
cause embarrassment. Treatment depends on the cause. Tremors caused by a medical condition
such as hyperthyroidism will likely get better when the condition is treated. If the tremors are
caused by certain medicine, stopping the drug usually helps them go away. Never stop taking
any medicine without first talking to the doctor.
Tow medications used to the treatment of the tremor includes:
- Propranolol: a drug that blocks the action of stimulating the neurotransmitters particularly those
related to adrenaline.
- Primidone: an antiseizure drug that also control the function of some neurotransmitters.
Other medications that may reduce tremor includes:
- Antiseizure drug such as gabapentin and topiramate.
- Mild tranquilizers such as alprazolarn or clonazepam
- Blood pressure drugs called calcium-channel blockers such as flunarizine and nimodipine.
- In severe cases, surgery to implant a stimulating device in the brain may be an option.
Combination drug therapies:
Primidone and propranolol may be used in combination if they have not sufficiently reduced
symptoms when used alone. In such cases, Primidone is usually prescribed at 25mg at bedtime.
The dosage is then increased gradually to 250 mg/day. Propranolol is then added to the drug
regimen, usually at 40 mg three times per day. Propranolol dosage may be increased to a
Maximum of 320 mg/day if the response remains inadequate. Alternatively, a long-acting
formulation of Propranolol may be substituted if once daily administration is desired.
Primidone (Mysoline):
Primidone, an anticonvulsant medication related to phenobarbital, slows the central nervous
system and helps to reduce or control seizure activity in certain types of epilepsy, In
addition, Primidone is considered a first-line therapy for the treatment of patients with
essential tremor. Primidone is usually prescribed at 25mg at bedtime. The dosage is then
increased gradually to 250 mg/day. Patients should not abruptly discontinue therapy with
Primidone. After consultation with a physician, the dosage is reduced gradually.
When treatment with Primidone is initiated some patients experience an acute idiosyncratic toxic
response to the drug. Symptoms of this type of reaction may include nausea, vomiting,
fatigue or sleepiness, confusion, and ataxia. This initial toxicity may occur in as many as
20%of patients. These symptoms typically resolve in one or two days. Additional
possible side effects of Primidone include vertigo, unsteadiness, irritability, blurred
vision, loss of appetite, or decreased sexual function. Primidone should be taken with meals
to help minimize gastrointestinal (GI) effects such as indigestion and G1 irritation. These
side effects are typically short-lived and disappear with continued therapy. Side effects
of chronic therapy are usually minimal and infrequent.
Prevention:
Stress and caffeine can make tremors worse. Avoid caffeinated drinks such as coffee, tea,
and soda, and other stimulants. Exercise and counseling to reduce emotional stress may
also help. Alcoholic beverages in small quantities may decrease tremors but can lead to
alcohol dependence and alcohol abuse, especially if they have a family history of such
problems. How alcohol helps relieve tremors is unknown,
Drug Tolerance:
Some patients may develop a tolerance for propranolol and Primidone over time. However,
propranolol and Primidone are effective long-term therapy for some patients with essential
tremor. Acute adverse reactions to initiation of Primidone therapy and side effects with
chronic use of propranolol may hinder continued therapy in some patients.