Tremor: therapies for the tremor

When muscles move uncontrollably, patients and doctors should seek the cause. Because there are effective treatment options

Does the finger tremble when touching the nose? Dr. Michel Rijntjes with a patient

© W & B / Nicolas Felder

From cold or fear, from exertion or excitement: it is quite normal for your legs, arms or hands to tremble from time to time. The muscles usually calm down quickly. But what if someone just shivers like that, for no apparent reason, over and over again?

Dr. Michel Rijntjes advises getting medical help as soon as such ailments arise. "Many causes can be treated. You just have to find them out," says the senior physician at the Neurological and Neurophysiological University Clinic in Freiburg.

Is it a drug to blame?

Often the family doctor or a resident neurologist can already identify the problem. If he or she finds that a drug is causing the tremors, he or she prescribes a different drug for the patient. Sometimes the solution is for the person to reduce stress, drink less coffee, and quit smoking. All influences that intensify the natural trembling of the muscles. But there are many other causes of what is known as tremor, harmless and serious.

Medicines as a trigger

There are many drugs that can cause the muscles to tremble as an undesirable side effect, especially if the dosage is too high. These include bronchodilators for people with asthma and COPD, the hormone thyroxine for patients with an underactive thyroid, and certain drugs for mental illnesses.

Patients who suspect such a side effect may exist should contact their doctor or pharmacist. Sometimes it is enough to replace the active ingredient with another one or to adjust the dosage. Under no circumstances, however, should those affected discontinue the medication prescribed by a doctor on their own initiative.

When does the tremor occur and how severe is it?

Finding clues about the trigger begins with simple tests. Doctors check whether the tremor occurs at rest, when moving or when holding, how fast and how pronounced it is. For example, the doctor asks the patient to raise both arms or move one index finger to the nose in one big movement.

If, for example, the tremor of the hand intensifies shortly before the finger reaches its target, there is a so-called intention tremor - which can be a sign of multiple sclerosis. The one-sided tremor at rest, in turn, indicates Parkinson's disease, provided there are other typical symptoms.

The most common form is essential tremor

In order to make a reliable diagnosis, many additional examinations are necessary. This includes the tremor analysis, which usually takes place in an outpatient clinic for movement disorders. By far the most common form of tremor can also be reliably detected there: the so-called essential tremor, which around a million people in Germany suffer from, i.e. about twice as many as Parkinson's and multiple sclerosis combined. Essential tremor can occur at a young age. But the risk increases with age. Around five percent of those over 65 suffer from it.

Postural tremor is characteristic of the disease: for example, when the arms are stretched forward and then tremble. But movement or intention tremors also occur. In the special laboratory, experts analyze the tremors using devices that measure the electrical currents of the muscles and the movements of the hand. If the two vibrate synchronously with each other and this rhythm is maintained even during the exercise with weights, the diagnosis of essential tremor is fairly certain - provided that the other findings also match.

When does the tremor need treatment?

For the patient, the diagnosis of "essential tremor" is often a great relief. Because essential tremor is not a disease that also affects the brain - unlike Parkinson's disease, for example. And there are no further complaints or restrictions. The neurologist Rijntjes said: "Some patients tell me that trembling is not that annoying. I can handle it." And leave the tremor lab without being prescribed any medication.

However, this only applies to mild symptoms. Because shaking alone can have a massive impact on the quality of life. For example, those affected keep dropping objects and cannot even hold a cup of coffee without spilling something. Or you get the feeling that during a conversation everyone is just staring at your hands, which are moving uncontrollably.

Patients react differently to medication

Medication helps most patients whose everyday life is impaired by an essential tremor. Beta blockers, which doctors usually prescribe primarily to lower blood pressure, are the first choice. Certain epilepsy drugs can also help reduce tremors.

"Unfortunately, it is not possible to predict which active ingredient the individual will respond to and what dosage this will require," explains Rijntjes. Doctors must therefore try out what works best for the patient. Sometimes it happens that the symptoms become increasingly difficult to get under control over the years with medication.

Deep brain stimulation

Then only the so-called deep brain stimulation remains as an option - a method in which electrodes inserted into the brain stop the tremors with light electrical currents. This procedure is also used to treat Parkinson's patients when drugs no longer do much and they are ready for this invasive procedure.

But the vast majority of tremor patients can be helped in a simpler way. The only requirement: the cause must be known. So it is worth doing a search to get a reliable diagnosis.