OVERVIEW

What is tremor?

Tremor refers to a rhythmic, involuntary, alternating oscillatory movement that can occur in the head and face, vocal cords, trunk, limbs, and other areas ^[1].

What are the types of tremor?

There are currently multiple classifications of tremor in the medical field. According to the 2018 consensus of the International Movement Disorder Society, tremor can be divided into three categories based on etiology: hereditary tremor, acquired tremor, and essential tremor ^[2].

SYMPTOMS

What are the common manifestations of tremors?

Tremors present differently depending on their etiology. Common manifestations can generally be summarized as follows:

1. Rapid, slight shaking in the head, face, vocal cords, trunk, or limbs when the patient is seated and not performing any voluntary movements (resting state).

2. The patient is standing or moving, accompanied by bradykinesia (slowed movement), muscle rigidity, abnormal posture and gait, asymmetrical movements, or difficulty walking backward.

3. Rapid shaking in the muscles when the patient exerts force against a fixed object, such as clenching a fist or lifting heavy objects.

4. Rapid shaking during fine motor activities, such as writing, playing the piano, or eating.

5. Rapid shaking as the patient approaches a target movement, such as when trying to pick up a book to read—the closer the hand gets to the book, the more pronounced the shaking becomes.

Some patients with tremors caused by illness, medication, or toxic substances may also experience other discomforts such as palpitations or excessive sweating.

CAUSES

What are the causes of tremors?

The causes of tremors mainly include physiological factors, pathological factors, genetic factors, and exposure to drugs or toxins.

1. Physiological factors. These are primarily caused by psychological factors such as tension and anxiety. Patients can alleviate their nervousness through appropriate psychological counseling and avoid stimulation in daily life, which will gradually relieve symptoms.

2. Pathological factors. If a patient experiences prolonged involuntary tremors, common causes include neurological disorders like Parkinson's disease, characterized by resting tremors that occur in the early stages of the disease, initially affecting one limb before progressing to both sides. Patients should promptly seek diagnosis from a neurology department. Endocrine disorders, such as hyperthyroidism, may also cause tremors, requiring brain CT and thyroid function tests.

3. Genetic factors. Essential tremor is generally considered related to genetic factors ^[3]. Tremors can be hereditary, and individuals with a family history of tremors have a higher likelihood of developing the condition.

4. Exposure to drugs or toxins. Examples include medications like sodium valproate (for epilepsy), metoclopramide (an antiemetic used after brain trauma or surgery), amiodarone (for arrhythmia), and tetrabenazine (an atypical antipsychotic), or exposure to toxins such as mercury, manganese, or carbon monoxide.

What are the risks of tremors?

Whether tremors are harmful depends on their underlying cause.

1. Tremors caused by physiological factors are generally harmless and disappear once the triggering psychological (e.g., stress, anxiety) or physical (e.g., cold, fatigue) factors are resolved.

2. Tremors caused by pathological factors can be harmful. Common pathological tremors may lead to chronic cerebellar damage, increased muscle tone, or secondary diseases.

   (1) Chronic cerebellar damage: Conditions like stroke, tumors, or multiple sclerosis that cause tremors can chronically damage the cerebellum.

   (2) Increased muscle tone: Tremors from Parkinson's disease can elevate muscle tone, leading to abnormal posture and gait, thereby impairing motor function ^[4].

   (3) Secondary diseases: For example, hyperthyroidism-induced tremors may also cause symptoms like bulging eyes, excessive sweating, and weight loss. Untreated, it can lead to conditions such as hyperthyroid heart disease or osteoporosis.

3. The harmfulness of genetically caused tremors depends on symptom severity.

   (1) Mild symptoms: Patients may experience difficulty with tasks like writing, drawing, or using utensils, limiting activities such as driving.

   (2) Severe symptoms: Prolonged and severe tremors can significantly restrict daily life, affecting activities like dressing, bathing, and communication. This may lead to low self-esteem, social withdrawal, and psychological issues like anxiety or depression, severely impacting quality of life.

4. Tremors caused by exposure to drugs or toxins are harmful. Such tremors often result from neurological damage and can be life-threatening in severe cases.

DIAGNOSIS

Which department should I visit for tremors?

Tremors can generally be addressed in the Neurology or Neurosurgery department. If tremors occur suddenly with severe discomfort, seek emergency care. The doctor will conduct further examinations based on the specific cause.

What symptoms of tremors require medical attention?

Determining whether tremors require medical attention depends on their underlying cause.

1. Tremors caused by physiological factors usually resolve once the triggering factor is removed and do not require medical attention. However, if tremors persist or worsen after the trigger is eliminated, seek prompt medical evaluation to identify other causes.

2. Tremors due to pathological factors require immediate medical attention. For example, if a patient with a pre-existing condition experiences tremors, urgent care is necessary to prevent rapid deterioration. Symptoms like abnormal mental states or confusion may indicate an emergency.

3. Tremors caused by hereditary factors—occurring without physiological triggers, drug/toxin exposure, or underlying diseases—require medical evaluation if they interfere with fine motor skills, stability, or coordination (e.g., hand shaking, head bobbing).

4. Tremors induced by medications or toxins (e.g., after taking certain drugs or exposure to toxic substances) demand immediate medical care, especially if accompanied by palpitations, sweating, or other severe symptoms, to prevent life-threatening complications.

What tests are needed to diagnose tremors?

Diagnostic tests vary based on symptoms and the doctor’s assessment.

For suspected hereditary tremors, tests may include brain CT, MRI, EEG, or thyroid function tests to rule out other causes.

If Parkinson’s disease is suspected, a brain MRI may be ordered.

For acute, severe tremors requiring emergency care, vital signs (temperature, blood pressure, heart rate, respiration) will be checked first.

TREATMENT

Does Tremor Need Treatment?

Whether tremor requires treatment depends on the underlying cause.

DIET & LIFESTYLE

What are the lifestyle precautions for patients with tremors?

Patients with tremors need to pay attention to adjusting their diet, improving negative emotions, modifying their lifestyle, and increasing physical exercise.

1. Adjust the diet. Patients with cardiovascular and cerebrovascular diseases can eat more anti-atherosclerotic foods, such as celery and onions. They can also consume more whole grains and high-protein foods, such as soy milk, eggs, and milk. Additionally, they should limit high-fat, high-calorie, and high-sugar foods, especially fried foods.

2. Improve negative emotions. In daily life, patients should maintain a happy mood and avoid excessive emotional agitation.

3. Adjust lifestyle. Drinking alcohol does not treat the disease but may worsen symptoms, so patients are advised to strictly abstain from alcohol. To facilitate the use of daily necessities, it is recommended that essential items be placed in easily accessible locations.

4. Increase exercise. During the recovery process, patients should engage in physical activities as much as possible, such as Tai Chi, gymnastics, and jogging.

PREVENTION

Can Tremors Be Prevented? How to Prevent Them?

The prevention of tremors varies depending on the underlying cause.