Is your tremor a sign of Parkinson's disease?
Your hands axe shaky. Over the years they've twitched every now and then whenever you wrote a note or used a tool or utensil. Now that you're older, those hand tremors are occurring a little more frequently, and you're concerned you might have something worrisome, like Parkinson's disease (PD).
Statistically speaking, you're more likely to be exhibiting signs of the most common type of movement disorder, benign familial essential tremor (ET), which is at least eight times more common than PD, according to the International Essential Tremor Foundation (IETF). Whatever the cause, if your tremors begin to affect your quality of life, it's time to find answers.
"When should you be concerned about tremors?" asks neurologist Tarannum Khan, MD, a Cleveland Clinic Florida movement disorders specialist. "With one episode of tremor, you should not be concerned at all. But, if it's more persistent and progressive over time, you should see a doctor."
Identifying Essential Tremor
ET often progresses slowly, and while for many patients it remains mild, for others it is life-altering.
Several factors can help you and your doctor determine if your shakiness is from ET or if it's a parkinsonian tremor. For instance, if you have a family history of tremor, you're more likely to have ET:
ESSENTIAL TREMOR VS. PARKINSON'S DISEASE 1 ESSENTIAL TREMOR PARKINSON'S DISEASE Typically occurs during an Tremors occur more often at rest; action, such as bringing a cup or most often affect the hands, but utensil toward your mouth. the legs also can be affected. Usually affects both arms or both Most often affects one side of sides of your body nearly your body more than the other; equally. eventually may progress to both sides. Most often causes shaky arms, Tremors almost never affect the hands or head or a trembling voice and head; PD manifests in voice; almost never affects the the head more as an opening and legs; manifests in the head as closing of the mouth, diminished side-to-side ("no-no") shaking facial expression ("masked" face) movements or head bobbing. and a drop in voice level (volume). Does not cause other health Often characterized by decreased disorders, such as immobility or dexterity on one side of the speech or memory problems. body, handwriting changes, stiffness and rigidity in the arms/legs, stooped posture, balance problems, short stride length, or shuffling gait. Symptoms may improve with May produce immobility, speech consumption of alcohol. problems, and memory loss. Family history of essential Family history of Parkinson's tremor present in the majority of disease present in fewer than 10 patients. percent of patients. Most commonly occurs in middle Generally develops between ages age, but can develop at any time 55 and 65. of life. Source: International Essential Tremor Foundation
More than half of patients with ET have a family history of the disorder, compared with less than 10 percent of those with parkinsonian tremors, according to the IETF.
Additionally, ET usually affects both sides of the body and occurs when you try to hold a body posture against gravity, reach toward something, or lift something toward you, Conversely, PD usually begins on one side of the body before progressing to the other side, and it occurs more often at rest. (See chart for other signs of ET versus PD.)
"Also, for Parkinson's disease, there are many, many other symptoms that accompany the tremor that are red flags that a person should definitely see a doctor," Dr. Khan says.
Finding the Cause
In some cases, your shakiness may not be a sign of ET or PD, but rather a different type of tremor or an underlying factor that your doctor must rule out, such as:
* Physiologic tremors, occurring in all healthy people and characterized by fine shaking of the hands and fingers.
* Other medical conditions, such as chronic liver or kidney disease, multiple sclerosis, low blood sugar, overactive thyroid (hyperthyroidism), traumatic brain injury, alcohol withdrawal, or severe anxiety.
* Use of medications/substances that cause tremors as a side effect. Some examples include divalproex (Depakote[R], used to treat seizures and bipolar disorder), certain antidepressants, asthma medications, immunosuppressants (e.g., cyclosporin and tacrolimus), caffeine, and nicotine.
No biomarker tests have been developed to definitively diagnose ET or PD, so Dr. Khan and other movement disorders specialists must rely more on their clinical expertise to pinpoint the cause of tremors.
"If someone has persistent tremors, it's best to see a neurologist, preferably one who is a movement disorders specialist," she advises. "A good examination by a movement disorders specialist usually is able to get the diagnosis."
If ET is affecting your quality of life, blood pressure medications known as beta blockers--usually propranolol (Inderal[R])--or the anti-seizure medication primidone (Mysoline[R]) may be prescribed. The wrinkle fighter botulinum toxin (Botox[R]) also may help. "If it's bothersome, it's a very good idea to get on a medication. We have very good medications for essential tremor and parkinsonian tremor," Dr. Khan says. "But, if it's mild, it's best left alone."
Also, in 2016, the U.S. Food and Drug Administration approved the first ultrasound device to treat ET. In this treatment, doctors use magnetic resonance imaging to target high-intensity focused ultrasound waves that destroy a tiny area of the brain believed to be responsible for ET.
If these non-invasive treatments fail, a surgical procedure known as deep-brain stimulation can provide dramatic relief for people with severe ET. A pacemaker-like device placed in the chest delivers electrical stimulation via electrodes placed in the brain to reduce tremors.
Like PD, ET is not curable, but its symptoms are manageable, Dr. Khan says. Simple lifestyle changes, such as limiting or avoiding caffeine, getting seven to eight hours of sleep each night, and finding ways to relax may help ease your symptoms. Also, take advantage of special utensils and assistive devices that can help you function better. Visit www. essentialtremor.org for more details.
"Benign essential tremor is more of a nuisance than it is a disease, as opposed to Parkinson's disease," Dr. Khan says. "The biggest issue with essential tremor is to manage life."