(.(.(. Tremors .).).)
So what's shaking! Tremors are a natural force in the body to help it adjust from a wide variety of strengths to subtle dexterity. It's only when the tremors get terribly out of control that we are faced with an embarrassing situation. It usually takes at least two groups of muscles to participate in a tremor. In some types of tremor, the groups of muscles will contract at the same time but with the stronger group of muscles winning. The results are the head, arm, fingers, or sometimes the legs moving in rhythmical patterns. In other types of tremor, there is an alternating pattern of contractions of the muscles. With this form of tremor, the groups of muscles take turns, first one group of muscles contracting, then the next, and so forth.
It may help to visualize these ideas. Most of the controlling mechanisms of the body are in a delicate balance. In general, if something comes along and destroys the fine balance, then there are consequences to pay. Torticollis is an example of how the fine delicate balance can be disrupted.
Let's image that you are watching some children in a playground. Two children of approximately the same age and weight get on a seesaw. If the children are fairly well balanced and sit still, the seesaw does not move. Now if the playground bully comes along and kicks one of the kids off and sits down, then the see-saw tilts and the bully usually goes to the ground (bullies usually being somewhat bigger and heavier than many of their peers). This is a good analogy for dystonia. When a group of muscles becomes too strong due to signals from the brain, that delicate balance is disturbed. Now back to our playground bully who does not care for sitting so close to the ground. So the bully leaves and another child of more equal size sits down. Because it is virtually impossible for two children to sit quietly without doing anything, the kids will do what comes naturally. They begin to rock the seesaw back and forth. The up and down/back and forth exchange of movement and energy is the same sort of mechanism that is responsible for tremor.
All of us have a tremor! It is a natural part of how we function. If you "normal" people wish to observe your tremor, simply take a piece of stiff paper and place it on the back of your outstretched hand and arm. After a brief moment, you will notice that the edges of the paper will begin to shake. The paper helps "amplify" that little tremor that is present in all of us, so that it may be observed. This is called a physiological tremor. It is present in everyone and with the correct coaxing it can be made more apparent. To see a physiological tremor get worse, simply contract the muscles involved with strong exercise and then do some activity more delicate, e.g., writing. I find that helping someone move big, heavy furniture through tiny doors and hallways is the best for identifying the tremulous response.
There are other more "pathological" forms of tremor. These other forms of tremor include benign essential familial tremor; the tremor associated with Parkinson's disease and the dystonic tremors which many of you are well acquainted with. There are tremors that are fast as well as slow. There are tremors that are present at rest and some present only with movement. There are some tremors that are present only in certain positions! There are tremors brought about by taking certain medications.
The difficulty with evaluating tremors is that for many people the tremors are very annoying but not necessarily life threatening. Often the movements themselves can be made worse by stressful social situations. This suggests to many unknowledgeable that tremors are of a psychiatric nature. Any neurological problem can be made worse by awkward social situations. However, with tremors, the whole world can see when you are stressed. The tremors can act as a lie detector informing others as to how comfortable one may be in any particular situation.
Medically evaluating a patient with tremors may also range from simple non-invasive tests such as an MRI to more aggressive evaluations. A good deal of the medical tests performed depend on how severely affected (physically, emotionally, financially) the patient is from their disease. Some of the evaluations also depend on how extensive the treatment issues will be for a patient in the future. Many patients respond to the use of medications, e.g., klonopin, primadone, propranolol. Others do not seem to respond at all to medications. A promising relatively new treatment for tremors is to implant a pace-maker type of device with wire electrodes implanted into a specific area of the brain using small electrical signals, which are generated in the pacemaker and travels through the wires to the area of the brain to stimulate nerves located there and attempt to achieve that balance once more. Similarly, a slightly different neurological approach is to destroy tissue in the brain to achieve that delicate balance.
Dr. James Auberle
Medical Advisor
Toldeo Clinic
4235 Secor Road
Toledo, OH 43623
(419) 479-5534
