Tremor Nədir

Tremor usually start asymmetrically, affecting only one side of the body, especially during early stages of the disease. With disease progression, both sides may become affected. Fatigue, stress or intense emotions can temporarily make tremors worse.

About 70-90% of people with PD experience a tremor at some point in their lives. Tremor appears to be slightly less common in younger people with PD, though it is still one of the most troublesome symptoms. People with resting tremor usually have a slower disease progression than people without tremor.

Tremor Ndir

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If dopaminergic medications (those that stimulate the parts of the brain affected by dopamine, a chemical necessary to controlled movements), such as levodopa, do not work to control tremor, other medications are sometimes used. For example, anticholinergics can be helpful for tremor. These medications improve Parkinson's symptoms by blocking the brain chemical acetylcholine. However, they can cause significant mental and physical side effects, so their use should be carefully considered. Anticholinergics are most useful in young people with tremor-predominant PD (when tremor is the main symptom that needs managing).

If medications are not effective, surgical interventions, such as deep brain stimulation (DBS), and focused ultrasound (FUS), can be effective in controlling tremor, even medication-unresponsive tremor. Talk to your doctor about DBS and other surgical options that may help with tremor.

In addition to medication and surgical treatment, there are assistive devices that can help with various activities of daily living. One of these is Liftware, a utensil with a stabilizing handle to counteract PD-related tremor. It is available with spoon and fork attachments and helps steady the hand, so it can make it easier to scoop up food and bring it to the mouth.

Purpose of review: Tremor may be defined as an involuntary movement that is rhythmic (ie, regularly recurrent) and oscillatory (ie, rotating around a central plane) and may manifest in a variety of ways; accordingly, tremor has a rich clinical phenomenology. Consequently, the diagnosis of tremor disorders can be challenging, and misdiagnoses are common. The goal of this article is to provide the reader with straightforward approaches to the diagnosis and treatment of tremors.

Summary: The evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the primary tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, primary writing tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common disorder of resting tremor. This article details the clinical features of each of these disorders, as well as those of additional tremor disorders.

PURPOSE OF REVIEW Tremor may be defined as an involuntary movement that is rhythmic (ie, regularly recurrent) and oscillatory (ie, rotating around a central plane) and may manifest in a variety of ways; accordingly, tremor has a rich clinical phenomenology. Consequently, the diagnosis of tremor disorders can be challenging, and misdiagnoses are common. The goal of this article is to provide the reader with straightforward approaches to the diagnosis and treatment of tremors.

SUMMARY The evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the primary tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, primary writing tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common disorder of resting tremor. This article details the clinical features of each of these disorders, as well as those of additional tremor disorders.

A tremor is an involuntary,[1] somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the hands. In some people, a tremor is a symptom of another neurological disorder.

Tremor can be a symptom associated with disorders in those parts of the brain that control muscles throughout the body or in particular areas, such as the hands. Neurological disorders or conditions that can produce tremor include multiple sclerosis, stroke, traumatic brain injury, chronic kidney disease and a number of neurodegenerative diseases that damage or destroy parts of the brainstem or the cerebellum, Parkinson's disease being the one most often associated with tremor. Lesions of the Guillain-Mollaret triangle (also called myoclonic triangle or dentato-rubro-olivary pathway) impair the predictions performed by the cerebellum, causing repetitive muscle discharges by triggering oscillatory activity in the central nervous system.[7] Other causes include the use of drugs (such as amphetamines, cocaine, caffeine, corticosteroids, SSRIs) or alcohol, mercury poisoning, or the withdrawal of drugs such as alcohol or benzodiazepine. Tremors can also be seen in infants with phenylketonuria (PKU), overactive thyroid or liver failure. Tremors can be an indication of hypoglycemia, along with palpitations, sweating and anxiety.Tremor can also be caused by lack of sleep, lack of vitamins, or increased stress.[8][9] Deficiencies of magnesium and thiamine[10] have also been known to cause tremor or shaking, which resolves when the deficiency is corrected.[11] Tremors in animals can also be caused by some spider bites, e.g. the redback spider of Australia.[12]

During a physical exam, a doctor can determine whether the tremor occurs primarily during action or at rest. The doctor will also check for tremor symmetry, any sensory loss, weakness or muscle atrophy, or decreased reflexes. A detailed family history may indicate if the tremor is inherited. Blood or urine tests can detect thyroid malfunction, other metabolic causes, and abnormal levels of certain chemicals that can cause tremor. These tests may also help to identify contributing causes, such as drug interaction, chronic alcoholism, or another condition or disease. Diagnostic imaging using CT or MRI imaging may help determine if the tremor is the result of a structural defect or degeneration of the brain.[13]

The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation. The selection of the sensors used is important. In addition to studies of muscle activity, tremor can be assessed with accuracy using accelerometers .[14]

There is no cure for most tremors. The appropriate treatment depends on accurate diagnosis of the cause. Some tremors respond to treatment of the underlying condition. For example, in some cases of psychogenic tremor, treating the patient's underlying psychological problem may cause the tremor to disappear. A few medications can help relieve symptoms temporarily.[citation needed]

Eliminating tremor "triggers," including stimulants such as caffeine, from the diet is often recommended.[17]Essential tremor may benefit from slight doses of ethanol, but the potential negative consequences of regular ethanol intake need to be taken into account. Due to the risks, alternatives such as "GABAergic drugs like sodium oxybate and NASs, LVA Ca2+ channel blockers like zonisamide, glutamate receptor antagonists like perampanel, and long-chain alcohols like 1-octanol" are preferred.[18][19] Beta blockers have been used as an alternative to alcohol in sports such as competitive dart playing and carry less potential for addiction.[20]

Physical therapy and occupational therapy may help to reduce tremor and improve coordination and muscle control for some patients. A physical therapist or occupational therapist will evaluate the patient for tremor positioning, muscle control, muscle strength, and functional skills. Teaching the patient to brace the affected limb during the tremor or to hold an affected arm close to the body is sometimes useful in gaining motion control. Coordination and balancing exercises may help some patients. Some occupational therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.[21]

Surgical intervention such as thalamotomy and deep brain stimulation may ease certain tremors. These surgeries are usually performed only when the tremor is severe and does not respond to drugs, and further evidence is required to determine the best course of treatment for any individual patient.[22][23][24] Response to surgeries can be excellent, reducing some symptoms such as "tremors, stiffness, slowness, and dyskinesias" for patients with Parkinson's Disease.[25]

Thalamotomy, involving the creation of lesions in the brain region called the thalamus, is quite effective in treating patients with essential, cerebellar, or Parkinsonian tremor. This in-hospital procedure is performed under local anesthesia, with the patient awake. After the patient's head is secured in a metal frame, the surgeon maps the patient's brain to locate the thalamus. A small hole is drilled through the skull and a temperature-controlled electrode is inserted into the thalamus. A low-frequency current is passed through the electrode to activate the tremor and to confirm proper placement. Once the site has been confirmed, the electrode is heated to create a temporary lesion. Testing is done to examine speech, language, coordination, and tremor activation, if any. If no problems occur, the probe is again heated to create a 3-mm permanent lesion. The probe, when cooled to body temperature, is withdrawn and the skull hole is covered. The lesion causes the tremor to permanently disappear without disrupting sensory or motor control. 2351a5e196