Trembling (muscle tremors, tremor) | Pharmacies Umschau

            

Doctors distinguish different types of tremors. In doing so, certain distinguishing features help them, for example, the question of how long the tremor already exists and whether the person concerned may have further movement disorders. This could be, for example, a changed gait or a striking muscle stiffness. The doctor should also be informed about mental changes.

Answers to the following questions are particularly important in the containment of a tremor:

• When does the trembling occur?

• How fast is the dithering?

• How Expansive is the dithering movement?

When will the trembling occur?

– There is the Ruhememor . As the name implies, it starts when the affected body region is not being moved and does not have to be held against gravity.
Example: The hand always begins to tremble when it lies relaxed in the lap. However, as soon as the hand is raised, for instance to reach for a coffee cup, the shaking stops or stops altogether. It therefore does not affect the affected person in everyday life. Nonetheless, quitting may of course be perceived as stressful.

– A action tremor begins, as its name suggests, during a muscle action. Again, there are variants:

– – The motion tremor generally applies to deliberately controlled movements, such as lifting of the arm towards coffee cup.

– – The intentional tremor is always noticeable when a specific target is targeted.
Example: The trembling begins when the hand touches the handle of the coffee cup and strengthens the closer the fingers get to the target. A revealing medical test is the finger-nose experiment: The patient is supposed to touch his own nose tip with his index finger in a relatively sweeping, large movement. The intention tremor occurs when the finger moves toward the tip of the nose and becomes stronger the closer it gets to the target. Trembling makes it difficult or impossible to accomplish the task.

– – The Haltememor describes a tremor in holding against gravity.
Example: If the coffee cup is held up for a while with the arm outstretched, the arm starts to shake.

How fast is the dithering?

Doctors state tremors according to frequency: There is the low-frequency tremor, ie a relatively slow tremor with a frequency of 2 to 4 hertz (Hertz = oscillations per second). In addition, there is the medium-frequency tremor with a frequency of 4 to 7, and the high-frequency tremor, ie a rapid tremor, with a frequency of over 7 hertz.

How spreading is the dithering movement?

A distinction is also made between the coarse (ie very large) trembling, the medium-sized and the subtle (ie minimally sprawling) trembling.

Confusing diversity and how trembling can still be classified

– A Resting Emmet for example, is a characteristic (but not a provocative!) Sign of Parkinson's Disease or Parkinson's Disease. The frequency is usually 4 to 6 or 7 hertz, so it is a medium-frequency tremors. If the hands are affected – often just one of them – it typically looks a bit like the patient counting invisible coins. That's why this tremor is called coin counter tremor.

Parkinson's can also trigger other forms of tremors. And not every resting tremor is caused by Parkinson's disease. For example, some medications can trigger this tremor type.

The therapy is primarily directed to the cause (for Parkinson's see below: "Overview: The three most common tremor forms").

– A Intentionstremor so trembling in a targeted movement often has its cause in the cerebellum, medically Cerebellum. This type of disorder is therefore called "cerebellar tremor". A common cause is the disease multiple sclerosis . An intention tremor can also have other triggers. For example, it can occur if alcohol abuse is persisted or it can be caused by some medications, for example lithium.
Therapy: Here, too, doctors go to the underlying disorder if possible. To what extent a drug suspected as a trigger can be changed, the doctor decides individually for each patient. However, do not self-administer a prescribed medication without consulting the doctor. Remedies that are more commonly used by neurologists against tremors, such as certain anti-spasmodic agents or beta-blockers, show isolated effects in this type of tremor. Under very strict indications, a so-called deep brain stimulation ("brain pacemaker", see "essential tremor") may be considered in individual cases. Your doctor and / or neurologist or neurosurgeon will thoroughly advise you on whether this procedure is really an option.

– On a tremor that is mainly as Haltememor It may be an intensified and therefore visible form of "normal", physiological tremor – especially if it has a medium to higher frequency. For example, muscle fatigue or anxiety may be the trigger, followed by different medications. Also, poisoning, alcohol, drug or drug withdrawal can reinforce a "normal" tremors. A more severe trembling occurs, for example, in severe liver or kidney disease (more on this in the section: "Overview: The Three Most Common Tremor Forms" below).

– More rare is a coarse holding and intention tremor copper storage disease Wilson's disease . In this hereditary disease, the body excretes too little copper . The consequence is harmful copper deposits especially in liver, eyes and brain .
Symptoms: The suspicion exists above all when other neurological symptoms appear in addition to shaking – especially in younger patients, and if there are already illnesses in the relationship gives.
Diagnosis: Pioneering are blood and urine tests, as well as an eye examination. A yellow-green ring around the cornea is often noticed.
Early diagnosis and a "decoppering" therapy are important to prevent (further) organ damage.

– Essential Tremor is the name of a very common form of trembling, which predominantly appears as a holding tremor, very rarely as a tense retro-tempo, in one part the affected person as intentional tremor. See also the section "The Three Most Common Tremor Forms"

The exact causes of the rather rare orthostatic tremor are also unclear.
Symptoms: It is noticeable as a high-frequency, not always visible trembling of the leg muscles. However, it can be palpable or registered by electrophysiological examination. Patients feel an insecurity when standing, sometimes even falling when they stand down. Rarely do they have problems walking, but not when lying or sitting.
Therapeutically, neurologists use, among other things, the drug gabapentin.

– The task-specific tremor is restricted to very specific, mostly very specialized activities, for example writing with a stylus or playing an instrument, or he acts as a voice tremor, so affects the speech.
Therapy: Certain methods of exercise have been developed to treat a writer's tremor. Also, special devices should be able to improve the handwriting. In the case of voice tremor, neurologists try to improve speech by means of a beta-blocker or botulinum toxin.

– The position-specific tremor is used in quite specific postures. For therapy, the exact classification of the disease plays a role. Neurologists also tend to be guided by their experience with certain treatments.

– The dystonic tremor is typically associated with dystonia. These include various movement disorders that usually manifest themselves in the form of cramps or poor posture. An example is the spastic wryneck as a nerve disorder. Recurring painful spasms of the neck muscles lead here to involuntary head postures forward, backward or to the side.
Diagnosis: Frequency and amplitude of this tremor are often irregular, which does not quite fit the definition of the tremor. Sometimes it is not possible for the neurologist to distinguish the dystonic tremor from a parkinsonian tremor (see below). For example, if needed, a specialized nuclear medicine imaging procedure called Brain Function SPECT (single photon emission computer tomography, FP-CIT-SPECT) can help.
Therapy: Botulinum toxin may be more effective against dystonic tremor of certain parts of the body, such as the head or the voice.

– The so-called Holmes tremor usually a slow, little rhythmic resting, holding and intention tremor, is caused by damage or degeneration of the central nervous system. So sometimes a stroke can be triggering.
Therapy: Various drugs, such as anticholinergics (inhibit the transmission of excitation to nerve endings), dopaminergics (are also used in Parkinson's disease) or a drug such as clozapine is trying to get better.

– Finally, nerve damage, so-called neuropathies, may be accompanied by tremor ( neuropathic tremor ). This rather rare tremor form is usually coarse and of medium to high frequency. For example, inflammatory autoimmune diseases that spread to nerves are sometimes the cause. Sometimes special hereditary diseases are responsible for a neuropathic tremor.
Therapy: Basic diseases are treated as specifically as possible by the doctor, to which the tremor then usually responds. Otherwise, neurologists may use a beta-blocker or certain antiepileptic drugs.

– Last but not least, tremors can also be psychologically conditioned ( psychogenic tremor ). This is suggested, for example, by a very unusual and "unphysiological" combination of various tremor types. If the trembling begins and ends abruptly, the type or intensity of the trembling changes when distracted, this can also be an indication of a mental triggers. From the examination of the muscular tension there are further indications.

Overview: The Three Most Common Tremor Forms

The frequency of increased normal, physiological tremor, essential tremor and Parkinson's tremor are among the most important types of tremors. Therefore, for these three forms further information.

Reinforced "normal", physiological tremor

Causes: Shutter strong stress muscular fatigue, emotions, such as pronounced anxiety, strong excitement or coldness are generally easy to understand. In addition, medicines, internal diseases and poisoning are possible. However, diagnosis always implies that the doctor will rule out a neurological disorder. Depending on the cause and the appropriate therapy, this tremor can also recede.
– – Triggering drugs: For example, certain (especially so-called tricyclic) antidepressants, lithium, valproic acid, some asthma medications, antiarrhythmics, psychotropic drugs like Neuroleptics, tamoxifen (a so-called antiestrogen used in the treatment of breast cancer ), some cytostatics (cancer drugs) and immunosuppressants .
– – Internal diseases as possible causes: Hyperthyroidism hyperparathyroidism, hypoglycaemia, too low blood calcium levels, vitamin B12 deficiency Kidney failure (renal insufficiency).
– – Poisoning also plays a role: Alcohol intoxication and withdrawal, drug withdrawal, various poisons.
Symptoms: A rather high-frequency tremor over 6 hertz, which manifests itself especially in holding positions (see explanation above).
Diagnosis: A detailed neurological examination is indispensable in most cases. Depending on the suspected diagnosis, the neurologist coordinates with the internist at an early stage. In neurological diagnostics, a electromyogram (measurement of electrical potential in muscles) and a lumbar puncture may be effective. Depending on the question, sometimes even different laboratory examinations and imaging procedures are necessary.
Therapy: It depends on the cause and its treatability. If a drug proves to be the trigger, the doctor will check to what extent a change is possible here. Otherwise, the neurologist will consider whether a predominantly halting tremor might be considered a beta-blocker, for example.

Essential tremor

Causes: disorders in certain areas of the brain, among others in the cerebellum, well behind the suffering. But the causes are not cleared yet. Not infrequently, there is a familial predisposition, which is why the tremor is also called familial trembling. It can be used in adolescence, but also in old age – and is therefore sometimes referred to as a "senile tremor", although it is actually not an "aging phenomenon". Most often he starts at the age of forty. Researchers are currently looking for co-responsible genes, because twin studies suggest genetic influences. Actually, the essential tremor is considered "harmless". It can, however, intensify, and the tremor can increasingly be perceived as disturbing or disabling.
Symptoms: Mainly there is a holding tremor. About half of those affected also show an action tremor, which can be very hindering. Rarely does a rest tremor occur. Most commonly both hands are affected, as well as in descending frequency the head, the voice, both legs and the trunk. The symptom improves with many sufferers when they drink alcohol. This effect can be extremely fatal – if it leads to a noxious type of "self-therapy" or the environment comes to the wrong conclusion, an alcohol problem could be the trigger. The tremor has mostly been around for a long time. Often those affected go to the doctor late, when they feel more disturbed by the tremors. Sometimes they also show a slight gait disturbance.
Diagnosis: Even the symptoms often refer to the diagnosis. The neurologist excludes other forms of tremor clinically as well as by electrophysiological examinations and internal diseases, including with the help of blood tests. In addition, there are special laboratory analyzes and imaging techniques for special questions (see, for example, above: Brain Function SPECT).
Therapy: Well-documented treatment options are available, for example in hand tremor with an antiepileptic drug such as primidone or with a beta-blocker or both , Secondarily, drugs such as gabapentin or topiramate are used. Agents such as clonazepam or clozapine are available as a reserve. In case of very severe expression of an essential tremor that can not be ameliorated by medication, the so-called deep brain stimulation may be a possibility. Neurosurgeons use electrodes from the outside deep into a specific brain area (intermediate brain) in a complex surgical procedure. The other end of the electrodes is connected to a pacemaker under the skin . With weak electrical impulses, nerve cells in the brain can be stimulated and thus inhibited by the pacemaker. The tremor can be suppressed with it.

In head tremors, beta-blockers such as propranolol and possibly deep brain stimulation are believed to have effects. Voice tremor is more commonly available to direct local botulinum toxin injections. All of these treatments require special experience.

From essential tremor, physicians delineate the so-called FXTAS or Fragile X Associated Tremor Ataxia Syndrome . Behind this there is a hereditary disease linked to the female sex chromosome X (women own two, men one). It is more likely to be seen in older men, more rarely in women. This leads to a pronounced action tremor and a disturbance of the movement coordination with uncontrolled and excess movements (cerebellar ataxia).

Trembling in Parkinson syndromes

The term Parkinson syndrome summarizes the different Parkinsonian forms, of which there are only four major groups, as
Symptoms: A resting tremor on one side of the body, rather above 4 hertz, is quite common in Parkinson's disease. This so-called Type I Parkinson's tremor is also characterized in that it lays down when the person concerned carries out a holding or other movement.
However, other forms of tremor can also occur as part of the disease. Thus, the Type II Parkinson's tremor consists of both a resting and a sustaining tremor, with a frequency difference of more than 1.5 Hertz. In particular, the holding tumor often proves to be very disabling for those affected. Type III Parkinson's tremor is a pure holding and action tremor, the opposite of type I, often with a frequency above 5 hertz. Other symptoms of Parkinson's disease are many. For example, striking motor deceleration (so-called bradykinesis) or uncertainty in movements due to disruption of certain reflexes can occur, as well as muscle rigidity.
Therapy: An important treatment goal is to make neurotransmitters in the brain, especially dopamine, more available again. There are preparations such as L-Dopa, a precursor of dopamine, or so-called dopamine agonists, which enhance the effect of the existing dopamine (dopaminergic substances). Doctors still treat a remaining tremor in a second step, for example with so-called anticholinergics. If Parkinson's tremor does not respond to medication, deep brain stimulation is an option.

For more information on the symptoms, causes, diagnosis, and treatment of Parkinson's disease, see Parkinson's Guide .

Attention: Therapies against tremor are medicated each affected person very individually, of course, taking into account the contraindications. It is always important to treat a possible underlying disease.

What is muscle twitching?

Most benign, short-lasting twitches, so-called benign fasciculations often occur in individual muscles of the leg. They are usually unrhythmic hence by definition no tremor, visible under the skin and not flowing into movements. Sometimes they are associated with muscle pain, tingling of the legs and calf cramps (so-called pain fasciculation syndrome). Rarely are the arms involved. Reinforcing can be muscular effort. In rest and relaxation, the symptoms usually subside. Neurological controls usually show that the symptoms remain unchanged for a long time. A morbid development is very rare.

As a so-called vegetative disorder, some stressed people occasionally feel a vibration twitch as trembling can be a "motoric expression" of excessive tension.

Lidflattern sometimes occurs in connection with a so-called arbitrary nystagmus. It usually comes to horizontal, very fast oscillations of both eyes. These movements can, as the name implies, be triggered arbitrarily, such as when the eyes fix a nearby object. After about 30 seconds, the abort is canceled, usually with facial movements and closing the eyelids. The "arbitrary nudge" is rare and not pathological; but apparently there is a predisposition to it. Occasionally he is supposed to be watching students (exhausted after hours of learning?) Students. The neurologist may be able to follow the voluntary "eye shaking" in an orienting examination of the eyes.

Go to the doctor, such as the neurologist, if you notice abnormalities such as tremors or muscle twitching. Only if the careful questioning of the complaints and the physical or neurological examination should give indications for a morbid cause, will a deeper diagnosis follow.