טרעמער

Tremor is the process of involuntary trembling of the body or its individual parts. It is regulated by nerve impulses and the contractility of muscle fibers. Most often, tremor is a symptom of pathological changes in the nervous system, but it can also be episodic, occurring after exercise or stress. Why does trembling occur, can it be controlled and when should I see a doctor?

אַלגעמיינע טשאַראַקטעריסטיקס פון דער שטאַט

Tremor is an involuntary rhythmic muscle contraction that a person cannot control. One or more parts of the body are involved in the process (most often occurs in the limbs, less often in the head, vocal cords, trunk). Patients of the older age category are most susceptible to chaotic muscle contractions. This is due to the weakening of the body and associated diseases. In general, tremor does not pose a serious threat to life, but significantly reduces its quality. The trembling can be so strong that it makes it impossible for a person to lift small objects or sleep peacefully.

מעגלעך סיבות פון אַנטוויקלונג

In most cases, trembling is caused by trauma or pathological processes in the deep layers of the brain responsible for movement. Involuntary contractions can be a symptom of multiple sclerosis, stroke, neurodegenerative diseases (for example, Parkinson’s disease). They can also indicate kidney / liver failure or a malfunction of the thyroid gland. In medical practice, there is often a predisposition to tremor due to genetic factors.

Sometimes trembling does not indicate a disease, but is a protective reaction of the body to external stimuli. Among them – mercury poisoning, alcohol intoxication, strong emotional stress. In this case, the tremor is short-lived and disappears along with the stimulus.

Trembling never occurs for no reason. If you cannot explain the origin of the tremor or its intensity looks frightening, consult a doctor.

Classification of involuntary contractions

Doctors divide tremor into 4 categories – primary, secondary, psychogenic and trembling in diseases of the central nervous system. Primary tremor occurs as a natural protective reaction of the body to cold, fear, intoxication and does not require treatment. The remaining categories are a manifestation of serious diseases that need medical attention.

Classification according to the mechanism of occurrence

Trembling can develop in only two cases – at the time of activity or relative rest of the muscles. Action tremor (action) is triggered during voluntary contraction of muscle fibers. To the signal that the nervous system sends to the muscle, several additional impulses are connected, which cause trembling. Action tremor can be postural, kinetic and intentional. Postural trembling occurs when holding a posture, kinetic tremor occurs at the moment of movement, and intentional trembling occurs when approaching a goal (for example, when trying to take something, touch a face/other part of the body).

Resting tremor occurs only in a relaxed state, disappears or partially dulls during movement. Most often, the symptom indicates a progressive neurological disease. As the disease progresses, the amplitude of fluctuations slowly increases, which seriously impairs the quality of life and limits the functionality of a person.

Types of tremor

The main types of tremor include:

1. Physiological tremor. Most often localized in the hands and practically not felt by a person. It is of a short-term nature and occurs against the background of anxiety, overwork, exposure to low temperatures, alcohol intoxication or chemical poisoning. Also, physiological trembling can be a side effect of the use of potent drugs.
2. Dystonic tremor. The condition is typical for patients with dystonia. In most cases, it occurs against the background of a dystonic posture and gradually intensifies as the disease develops.
3. neuropathic tremor. Postural-kinetic trembling, most often caused by a genetic predisposition.
4. Essential tremor. In most cases, localized in the hands, is bilateral. Muscle contractions can cover not only the arms, but also the torso, head, lips, legs, and even the vocal cords. Essential tremor is genetically transmitted. It is often accompanied by a mild degree of torticollis, muscle tone in the extremities, and spasm during writing.
5. Iatrogenic or drug tremor. Occurs as a side effect from the use of drugs or unskilled actions of a doctor.
6. Parkinsonian tremor. This is the so-called “quivering rest”, which weakens at the moment of movement or any other activity. The symptom is characteristic of Parkinson’s disease, but can also occur in other diseases with parkinsonism syndrome (for example, with multisystem atrophy). Most often localized in the hands, sometimes the legs, lips, chin are involved in the process, less often the head.
7. Cerebellar tremor. This is an intentional tremor, less often manifested as postural. The body is involved in the process of trembling, less often the head.
8. Holmes tremor (rubral). A combination of involuntary postural and kinetic contractions that occurs at rest.

פֿעיִקייטן פון טעראַפּיע

Muscle contractions do not always need treatment. Sometimes their manifestations are so insignificant that a person does not feel much discomfort and continues to function in the usual rhythm. In other cases, the search for a suitable treatment directly depends on the diagnosis.

ווי איז טרעמער דיאַגנאָסעד?

Diagnosis is based on the study of the patient’s medical history, physiological and neurological examination. At the stage of physiological examination, the doctor reveals the mechanism of development, localization and manifestations of tremor (amplitude, frequency). Neurological examination is necessary to compile a complete picture of the disease. Perhaps involuntary trembling is associated with impaired speech, increased muscle stiffness, or other abnormalities.

After the initial examination, the doctor issues a referral for general urine and blood tests, biochemical blood tests. This will help eliminate metabolic factors for the development of tremor (for example, malfunctioning of the thyroid gland). Subsequent diagnostic manipulations depend on the individual characteristics of the patient. For example, a specialist may prescribe an electromyogram (EMG). EMG is a method for studying muscle activity and muscle response to stimulation.

In case of brain injuries, they give a referral for CT or MRI, and with severe trembling (a person cannot hold a pen / fork) – for a functional study. The patient is offered to perform a series of exercises, according to which the doctor evaluates the state of his muscles and the reaction of the nervous system to a particular task. The exercises are very simple – touch your nose with your fingertip, bend or raise a limb, and so on.

Medical and surgical treatment

Essential tremor can be treated with beta-blockers. The medication not only normalizes blood pressure, but also eliminates stress on the muscles. If the body refuses to respond to a beta-blocker, a doctor may prescribe special anti-seizure medications. For other types of tremor, when the main treatment has not yet worked, and you need to get rid of the tremor as soon as possible, tranquilizers are prescribed. They give short-term results and can cause drowsiness, lack of coordination and a number of unwanted side effects. Moreover, the regular use of tranquilizers can cause dependence. Botulinum toxin injections or high-intensity focused ultrasound can also be used for therapeutic purposes.

Do not self-medicate. Strictly follow the doctor’s recommendations, do not change the indicated dosages, so as not to aggravate the situation.

If medical treatment is ineffective, doctors use surgical methods – deep brain stimulation or radiofrequency ablation. What it is? Deep brain stimulation is a surgical procedure in which a pulsed device is inserted under the skin of the chest. It generates electrodes, sends them to the thalamus (the deep brain structure responsible for movement), and thereby eliminates the tremor. Radiofrequency ablation heats the thalamic nerve, which is responsible for involuntary muscle contractions. The nerve loses the ability to generate impulses for at least 6 months.

Medical prognosis

Tremor is not a life-threatening condition, but it can significantly affect quality of life. Daily routine activities, such as washing dishes, eating, typing, cause difficulties or are completely impossible. Additionally, tremor limits social and physical activity. A person refuses to communicate, habitual employment, in order to avoid awkward situations, embarrassment and other things.

The medical prognosis depends on the root cause of rhythmic contractions, their variety and individual characteristics of the organism. For example, manifestations of essential tremor may increase with age. Moreover, there is evidence that involuntary shivering is associated with an increased risk of developing other neurodegenerative conditions (such as Alzheimer’s disease). Physiological and drug tremors are easily treatable, so the prognosis is favorable for them, but it is much more difficult to eliminate hereditary factors. The main thing is to consult a doctor in a timely manner and start therapy.