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Tremor

A tremor is an uncontrollable movement that affects a part of the body, for example the hand.

Tremor (shaking) is one of the main symptoms of Parkinson's, alongside slowness of movement and rigidity (stiffness). Not everyone will experience all of these symptoms.

Different types of tremor

Having a tremor is a common feature of Parkinson’s, but it doesn’t necessarily mean you have Parkinson’s. It can also be a symptom of other conditions.

  • essential tremor is a trembling of the hands, head, legs, body or voice and is most noticeable when you are moving. This is a common type of tremor and as such, often mistaken for Parkinson's.
  • dystonic tremor. This can occur because of dystonia (a range of movement disorders that cause muscle spasms and contractions).

It can be difficult to tell essential and dystonic tremor apart from a Parkinson’s tremor.

What is a Parkinson’s tremor?

A tremor caused by Parkinson’s can appear in 2 ways:

  • A resting tremor. This might happen when your body is still and relaxed, for example when you’re lying in bed. The most typical tremor in Parkinson’s is called a ‘pill-rolling’ rest tremor, as it looks like you are trying to roll a pill between your thumb and index finger.
  • An action tremor. This can happen when you’re doing something, like trying to hold a magazine or drink from a cup.

Usually, a specialist will be able to carry out a clinical assessment to see whether you have Parkinson’s tremor or a different kind. Sometimes, further tests, such as a brain scan called a DaTSCAN, may be helpful.

Speak to your doctor or nurse if you’re experiencing a tremor.

What causes a Parkinson’s tremor?

People with Parkinson's don't have enough of a chemical called dopamine. This is because some nerve cells in their brain that produce dopamine have died. Without it, the symptoms of Parkinson’s appear, and may include a tremor.

For some people, a tremor might be the first symptom of Parkinson’s. But this will vary because not everyone with Parkinson’s experiences the same symptoms.

If I have Parkinson's, will I eventually develop a tremor?

It’s not possible to predict whether or not you will develop a tremor, as the condition varies from person to person.

Will my tremor get worse as my Parkinson’s progresses?

Although medication may help control a Parkinson's tremor, it usually gets worse over time. However, this is generally quite a slow process that happens over several years.

For many people with Parkinson’s, their tremor isn’t constant and how it affects them can also change a lot. 

Typically, a Parkinson’s tremor starts in the hand before ‘spreading’ to affect the rest of the arm. The tremor can also spread to affect the foot on the same side of the body.

Occasionally, a Parkinson’s tremor starts elsewhere, for example in the foot, then it may spread up the leg and then into the arm. After several years, the tremor can spread to affect the other side of the body.

In severe cases, the tremor can affect other parts of the body, including the lips or jaw.

Some people also experience an ‘internal tremor’. This is a feeling of tremor within the body which isn’t noticeable to other people. The treatment for internal tremor is the same as for an external one.

Some people can develop tremor-dominant Parkinson’s. This is where a tremor becomes the main symptom that needs managing. People usually experience fewer falls and problems with mobility when this happens.

If your tremor does get worse, speak to your GP, specialist or Parkinson’s nurse about the symptom change. 

Can anything else make my tremor worse?

If you have Parkinson’s, you might find your tremor gets worse in stressful situations. This is temporary and the tremor should settle when you’re feeling more relaxed.

Some drugs, such as tranquilisers, anti-sickness and anti-dizziness medications, can make a Parkinson’s tremor worse. Some anti-asthma drugs, antidepressants and anti-epileptic drugs could also make your tremor more noticeable.

It is worth looking at the product information sheet that comes with any medication you are prescribed to see if that particular medicine can either cause or make a tremor worse.

However, you might still need to take these medications, so if you have any concerns about the drugs you take, speak to your GP, specialist or Parkinson’s nurse.

How can I manage my tremor?

There is no cure for a tremor, but there are ways to manage the symptom.

In the early stages of Parkinson’s, some people might be able to suppress their hand tremor by squeezing or rolling a ball, pen or similar object.

Speak to your specialist or Parkinson’s nurse for advice. You may also find it useful to speak with other people who are experiencing tremor, to find out what they do to help.

There are also other things you can do to help control your tremor:

Medication

Usually, drug treatments for Parkinson’s can help control a tremor. This includes levodopa (sometimes known by brand names including Sinemet and Madopar) and some dopamine agonists.

There are other drugs that may also lessen your tremor. As everyone with Parkinson’s has a different experience of the condition, it’s best to speak to your GP, specialist or Parkinson’s nurse about possible medication options for you.

Stress relief

Anxiety or stress can make a tremor worse, so it’s important to find ways to relax.

Exercise may help and also improve your sense of wellbeing. Some people have also found complementary therapies, such as aromatherapy, yoga, reflexology and music and art therapy, have helped them to relax.

Deep brain stimulation

Deep brain stimulation (DBS) is a form of surgery that is used to control some of the symptoms of Parkinson’s, including tremor. It involves passing small electrical currents through electrodes that are permanently implanted in the brain.

Deep brain stimulation isn’t a suitable option for everyone and, like any surgery, there are some risks involved. You may be offered this type of treatment if your symptoms are severe and medical treatment is no longer effective.

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