Whenever a person is seen to have hand tremors, the thought of Parkinson’s jumps first into our heads. Often these tremors start making one withdraw socially. But are all hand tremors due to Parkinson’s?
Parkinson’s – What is it, why does it happen and how does it present itself……
Parkinson’s disease is a result of degeneration (deterioration or slow damaging of the nervous system) and a decrease in a chemical called dopamine. It is usually seen after the age of 50 years but there are some young-onset variants. Early symptoms like tiredness, sleeping problems, constipation or even a loss in smell may go unnoticed, till the tremor comes on.
Apart from tremor, other symptoms of Parkinson’s include slowing down and difficulty of some movements like swinging your arms, getting out of bed, taking long walking strides, and turning around which may result in moving with slow small steps, and episodes of losing balance. Also, the characteristic is the reduction in facial expressions and blinking. Gradually mental faculties deteriorate like memory, grasping power, and reasoning with more of anxiety or depression, sweating, confusion, forgetfulness and even a change in handwriting (becomes small and cramped) setting in. Advanced cases may show drooling, difficulty in swallowing and speaking, difficulty in passing stool/urine, or inability to have an erection. As muscle weakness and stiffness slowly set in all over the body, one may be unable to stand, have pain and require assistance in moving and in many daily activities.
Coming back to the classic Parkinson tremor, if some of the above symptoms co-present themselves, the diagnosis is pretty obvious, and usually, medicines which increase the chemical –dopamine and its action are administered in treatment. However, if only a tremor is seen, sometimes it may be hard to be sure of the cause.
The Parkinson Tremor…..
Tremor is a sign in almost 80% Parkinson cases and has some features which set it apart-
- Usually starts on one side and then may go on to the other side.
- Though the hand is the most common, well known and visible tremor site, Parkinson tremors can also occur in legs, feet, jaw, chin, mouth, or tongue
- Tremors of the head and voice are rare.
- Parkinson tremor has rolling typicality where the thumb rolls something on the other fingers.
- A typical Parkinson tremor occurs at rest (when not doing any activity).
- The tremor disappears with movement and comes back on holding something for a long time like a spoon etc.
- Apart from having social repercussions, the tremor itself usually does not interfere with daily activities.
Tremors which are not Parkinson’s….
Even normally, tremors may be seen like after exercise, stress, fear, anxiety, exposure to cold, injury, fever or infections, lifting heavy things, taking certain medicines, alcohol intake or withdrawal, or too much caffeine. These are usually temporary and should be ruled out as the cause of tremor, by observation of daily lifestyle. Some of these factors can also bring on a benign essential tremor.
Benign Essential Tremor – how is it different from Parkinson’s…..
Another cause of tremor which is more common than Parkinson’s often runs in families, and is also seen usually past the age of 50, is called benign essential tremor. The word ‘essential’ here relates to no cause, no other symptoms or no other associated neurological problem seen to exist with it. ‘Benign’ means not harmful or life-threatening.
- Usually affects both sides together.
- Once again here the hands are the most commonly affected areas, but the head, neck, tongue, voice (quivering of voice), face (twitching), forearms and even the trunk can show tremors.
- Tremors of legs or feet are rare.
- Tremors are rapid, rather like a hand shiver, and not like the typical rolling tremor of Parkinson.
- Unlike the Parkinson tremor (seen at rest), the essential tremor is more of action tremor and comes on usually when doing an activity like writing (handwriting can get distorted and bigger), tying or picking up something, but rarely may happen at rest also.
- Tremor may be brought on by emotional stress, fatigue, hunger, drastic temperatures, caffeinated drinks, and smoking.
Usually, essential tremor doesn’t need treatment. If it starts to interfere with daily activities, some medicines like tranquilizers or some medicines which reduce the activity of adrenalin may be prescribed along with some physical and lifestyle advice. There are people who developed an essential tremor but later also went on to develop Parkinson’s. So, it’s not as if the two are directly related but can in some cases happen to the same person.
Any other causes of tremors one should know?…..
Multiple Sclerosis (MS) is a condition in which the protective sheet covering the nerves is lost, therefore the nerves get inflamed, and damaged. The tremor in MS can occur at rest, with activity and even while lying. MS has a younger age of onset compared to Parkinson’s, though some of the symptoms may be similar between the two. The differentiating features are the presence in MS of extreme fatigue, difficulty in walking, pain and touch-temperature sensitivity, dizziness, vision problems, and electric shock sensations on neck movements. The slowness of movement, stiffness, loss of facial expression and the small crawling handwriting are typical of Parkinson, not MS.
Sometimes hyperactivity of the thyroid gland can produce a fine tremor along with other symptoms like weight loss, palpitations, nervousness, inability to sleep, irritability, tiredness, heat intolerance and bulging out eyes. The gland itself may be enlarged or swollen in the neck. Tremors may also be seen in kidney or liver failure, sudden drop in sugar especially in people with diabetes, or after brain injury or stroke. So, running a few lab tests can help in eliminating and landing on the diagnosis when in doubt.
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