Tremor

A tremor is the uncontrolled shaking or trembling of one or more parts of the body. This is usually caused by a problem in the brain or the nervous system and can occur with various conditions.

A tremor occurs most often in the hands, but can also appear in other parts of the body, such as the head, the vocal cords or the legs. Tremors vary in severity, from small tremors to more pronounced shaking.

Causes of tremors

There are different causes of tremors:

• Unknown cause. Essential tremor is the most common form of tremor and can occur at any age. The precise cause is unknown. There is often a hereditary predisposition, so it also occurs in family members.
• Parkinson's disease. A hallmark of Parkinson's disease is a shaking hand. The cause is a shortage of the substance dopamine in the brain.
• Brain (cerebellar) damage. This tremor occurs due to damage to the cerebellum (the small brain) as a result of a stroke, tumor or other neurological condition.
• Other diseases. For example, diabetes, multiple sclerosis (MS) or a metabolic disease.
• Toxic exposure. Some toxic substances cause tremors when you are exposed to them.
• Psychological cause. Some tremors arise due to psychological factors, such as stress or anxiety.
• Alcohol or medication. Excessive alcohol consumption or certain medicines can cause tremors.

Different types of tremors

In addition to different causes, there are also different types of tremors. The most common types are:

• Resting tremor. This occurs when the body part is at rest and disappears with movement. It often occurs in Parkinson's disease and usually affects the hands, arms, legs or chin.
• Action tremor. When performing a goal-directed movement, such as writing, eating or drinking, this tremor emerges. It often goes together with an essential tremor and usually affects the hands, arms, head or vocal cords.
• Postural tremor. Taking or holding a certain posture, such as extending the arms, is accompanied by shaking. The postural tremor often occurs in combination with an essential tremor and usually affects the hands, arms or head. The tremor usually disappears when the body part is at rest.
• Intention tremor. This tremor occurs when approaching a goal, such as touching an object. It gets worse as one gets closer to the goal. It often occurs in MS and usually affects the hands, arms or legs.
• Flapping tremor. With a flapping tremor, the hands and arms start to 'flap' when they are stretched out. This tremor is the result of brain damage, a metabolic disease, or when the liver or kidneys fail.
• Orthostatic tremor. With this tremor, it is difficult to stand firmly (and remain standing). From the outside, this is barely or not visible. The cause is unknown.

How does a tremor affect daily life?

The consequences of a tremor for daily life vary greatly from person to person. This depends, among other things, on the severity of the tremor, when it occurs, and what activities, work and hobbies someone has in their daily life.

A tremor can cause difficulties with activities such as walking, cycling, eating, showering, brushing teeth, working on the computer, cooking and social interactions. People with a (severe) tremor can also feel isolated and down due to shame or the inability to carry out activities.

Treatment of a tremor

Treatment depends on the type of tremor, its severity and the underlying cause. In consultation with the GP or neurologist, the most suitable treatment is chosen. Examples include:

• Medication. For some types of tremor, medicines are available that reduce the symptoms. Depending on the diagnosis, these may be beta-blockers, dopamine enhancers, tranquilizers or botox injections.
• Deep brain stimulation. This is a surgery in which electrodes are placed in the brain to control the tremor. This method is often used in Parkinson's disease.
• Physical therapy. Helps improve muscle strength, coordination and balance.
• Occupational therapy. Helps adapt the living environment and use aids for daily functioning.
• Good self-care. Better coping with stress, sufficient sleep, limiting alcohol and caffeine, quitting smoking and relaxation techniques can help reduce tremors. For this too, help from a specialist, such as a psychologist, may be needed.