Tremors, sometimes called shakes or twitches, are defined as involuntary spontaneous body part oscillations affecting any muscle group but with the most commonly involving the hands and arms. There are a wide range of causes for these movements some innocuous, some progressive and some debilitating in the long run.
At some point, most of us have experienced an annoying eye twitch, a form of eye muscle fatigue from too much internet or reading, common in students cramming for exams. If persistent, the complaint warrants a full medical exam. Equally prevalent are the physiologic tremors. Emotionally induced shakes, third cup coffee jags and the ubiquitous morning after the night before syndrome being the most prevalent. All share the common factor of being temporary with no long term consequences. “Shakes”, however, in the insulin medicated diabetic, are a warning sign of impending hypoglycemia with the potential for major harm and must receive adequate and immediate medical intervention. Not as prevalent today as in past generations is the DT delirium tremens a potentially life threatening withdrawal state with chronic alcohol poisoning. Today, we are more likely to see people showing up in emergency rooms with shakes caused by any number of recreational substance abuses. Even properly prescribed pharmaceuticals will list tremors and coordination disorders as their side effects in a small percentage of patients.
Tremors can also be an early manifestation of multiple sclerosis, stroke aftermath, and several neurodegenerative diseases. Facial muscle twiches are often overlooked in their early stage. Brain stem injury can manifest itself with rhythmic and involuntary facial movements including soft palate contractions creating a clicking sound. Sometimes in disorders of the cerebellum coordination center especially tumors, strokes and MS; the patient will “overshoot” in the direction of intended movement. Attention needs to be paid to voice “warbles” or speech waverings in the senior age groups. Speech is the result of exhaled air moving across controlled muscle contractions in the larynx. Any number of brain stem pathologies can alter the voice.
But the two pathologies about which i receive the greatest number of enquiries are BENIGN ESSENTIAL TREMOR and PARKINSON’S DISEASE. They are both afflictions of the mature population with B.E.T. by far the commonest tremor disorder. I’ve never personally liked the term benign. It suggests an innocuous condition but which actually may incapacitate some patients; though it never presents with the cardinal symptoms seen in the Parkinson patient The “essential’ component of B.E.T. is the movement disorder itself unassociated with any other major organ system manifestations whereas the Parkinson patient will demonstrate cognitive impairments, mood disorders and very often loss of smell. Parkinson very often includes speech and swallowing problems including drooling and the classic “facial mask” of reduced expression. B.E.T. patients exhibit an increase in tremor with deliberate movement with lessening of the symptoms at rest. The Parkinson tremor on the other hand, is apparent at rest often in the form of the classic “pill roll” between thumb and index finger and is seen along with limb rigidity and slowness of deliberate limb movement.
B.E.T. is not well understood at this time and appears randomly in the population whereas Parkinson has been studied extensively with a body of evidence there is a genetic and gender component. We know enough about the workings of dopamine receptors in neurophysiology that a number of effective treatments are available.
Movement is the result of a complex series of chemical actions initiated in the brain producing nerve conduction of messages to selected muscle groupings which in turn have their own complex chemical processes to produce the required response. Tremors may be a nuisance with a logical source…but they may also represent an early presentation of sinister internal pathology and therefore must never be ignored.
Written by: Dr. David Carll