Tremor, also known as shaking disease, is a neurological disorder that causes involuntary and uncontrollable shaking or trembling movements, usually seen in the hands but also affecting the arms, legs, head and vocal cords.

Although tremor is not life-threatening, it can cause disability. It can also make it difficult to perform routine tasks of daily living, such as writing, eating, shaving, and dressing.

What are the types of tremor?

Tremor is a neurological disorder that causes involuntary shaking or shaking movements, of which there are several types. Tremor is classified into two main types: resting tremor and action tremor. Resting tremor occurs when the body remains motionless or lying down but generally decreases with movement. This type of tremor typically affects the hands and fingers. Action tremor, on the other hand, occurs when the arms are held horizontally or during movement. Action tremor is further divided into the following subcategories:

• Intention tremor: Tremors that occur during purposeful movements are called intention tremors.
• Postural tremor: It is a type of tremor that occurs when maintaining a certain position in situations such as excitement, tension or fear.
• Task-specific tremor: Tremors that occur during a specific task or activity are called task-specific tremors.
• Isometric tremor: The tremor that occurs after holding an object or a heavy load in the same position for a long time is called isometric tremor.

Tremor disease is also classified according to appearance and causes as follows:

• Essential tremor: A neurological condition that results from communication problems with the relevant parts of the cerebellum, which control muscle coordination, causing involuntary rhythmic shaking and shaking. Tremors typically occur in the hands and arms, but can also affect the head, vocal cords, and lower limbs. They typically begin in adolescence or middle age. While the exact cause is unknown, hereditary factors may be involved.
• Dystonic tremor: A type of tremor in which muscles become overactive and unintentionally move due to a misunderstanding of signals from the brain. It occurs in young or middle-aged individuals and can affect any muscle in the body.
• Cerebellar tremor: This tremor worsens after purposeful movements. Tremors can occur in the arms, legs, hands, or feet and are often caused by stroke, tumor, or inherited disorders.
• Functional tremor: Also called psychogenic tremor, this type begins suddenly with different symptoms and can change as attention increases or decreases.
• Enhanced physiological tremor: A type of tremor that occurs especially in the hands and fingers and can be caused by medications, alcohol withdrawal, or medical problems.
• Parkinsonian tremor: A symptom of Parkinson's disease. It can affect the hands, jaw, face, lips, and legs.
• Orthostatic tremor: This refers to tremors in the legs that occur when standing. It usually stops when sitting or walking begins.

These various types of tremor present with different symptoms that reflect different aspects and effects of the disease.

Causes of Tremor

Tremor can occur for a variety of reasons, causing involuntary shaking or shaking movements. The most common causes include:

• Genetic predisposition: Family history may increase the risk of developing tremor. Genetic factors are thought to play a role in the development of this disease.
• Neurological problems: Neurological problems such as multiple sclerosis, Parkinson's disease, stroke, and traumatic brain injury can cause tremors.
• Hormonal problems: Hormonal disorders such as kidney failure and hyperthyroidism can also contribute to tremors.
• Alcohol withdrawal: Excessive alcohol consumption followed by sudden cessation can cause tremors. This usually manifests as tremors in the hands.
• Anxiety and stress: High levels of stress, anxiety, and panic attacks can also trigger tremors.
• Medications: Some medications, especially those used for asthma, psychiatric or neurological disorders, can cause tremors.
• Toxin exposure: Exposure to toxins such as heavy metals (mercury, manganese, lead, arsenic), neurotoxins, and pesticides may increase the risk of tremors.
• Caffeine consumption: Excessive caffeine intake can cause fine tremors, especially in the hands.
• Thyroid disorders: Hyperthyroidism, where the thyroid gland is overactive, or hypothyroidism, where the thyroid gland is underactive, can cause tremors.
• Liver and kidney failure: Organ failures can cause chemical imbalances in the body and disturbances in nervous system functions, causing tremors.
• Diabetes: Diabetes can cause nerve damage, which can trigger tremors.

The factors that cause tremors can be diverse and vary from person to person. The exact cause and triggers may vary depending on a person's medical history and lifestyle.

Tremor symptoms

Symptoms of tremor include rhythmic shaking or trembling movements in various areas. These symptoms include:

• Shaky hands, arms, head, legs, or trunk: Tremors usually begin in the hands but can spread over time to other areas, such as the arms, head, legs, or trunk. Rhythmic shaking or trembling movements occur in these areas.
• Tremor: In some cases, tremor can affect the vocal cords, causing a trembling voice. This can cause the voice to tremble involuntarily when a person speaks.
• Difficulty writing or drawing: People with tremors may have difficulty performing fine motor skills such as writing or drawing due to tremors in their hands. The writing or lines may be uneven.
• Difficulty holding and controlling objects: Difficulty holding, grasping, and controlling objects are also symptoms of tremors. This can be particularly difficult with tasks requiring fine motor skills.
• Trigger factors: In some cases, factors such as stress, intense emotional states, physical fatigue, or making certain movements can trigger or aggravate tremors.

The symptoms of tremor can vary from person to person and can vary in severity. These symptoms can often interfere with activities of daily living, causing difficulty.

How is tremor diagnosed?

Diagnosing tremor is usually done by a specialist doctor and may include the following steps:

• Physical Examination: A specialist will perform a physical examination to assess the patient's general health. The severity and extent of tremors are noted, as well as the areas affected.
• Medical history assessment: The doctor will ask a detailed medical history and symptoms of the patient. Important information, such as family history, medication use, and exposure to toxins, will be reviewed.
• Neurological Examination: The specialist conducts a neurological examination to assess the patient's neurological status. This examination examines factors such as muscle tone, reflexes, muscle strength, and coordination.
• Assessment of tremor characteristics : The characteristics of tremor movements are observed. This focuses on questions such as whether tremor movements occur at rest or during movement, and how the tremor's rate and magnitude change.
• Laboratory tests: A doctor may evaluate a patient's biochemical and hormonal status by taking blood or urine samples. These tests can help identify underlying causes.
• Imaging tests: In some cases, if brain or nervous system lesions are suspected as the cause of tremors, imaging tests such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) may be ordered.
• Medication and trigger tests: The doctor may perform various tests to determine if the tremor is triggered by certain situations or medications.

Accurately diagnosing tremor requires considering factors such as the type, severity, and cause of the tremor. These steps help accurately diagnose the condition and develop an appropriate treatment plan.

How is tremor treated?

Treatment for tremor may include various methods to alleviate symptoms. However, the same treatment approach may not be appropriate for every type of tremor. Some of the treatment methods for tremor include:

• Medication: Certain medications can help reduce the severity of tremors. Medications such as beta-blockers, anticonvulsants (seizure preventers), and tranquilizers may be used. However, medications can have different effects on each individual and may not be effective in some patients.
• Surgical interventions: If medications are insufficient or if tremors significantly impact daily life, surgical options may be considered. Surgical procedures such as deep brain stimulation (DBS) involve implanting electrodes into the brain and sending electrical signals through these electrodes to control tremors.
• Botox injections: Botox injections can be used for tremors, particularly in the face or head. Botulinum toxin can help reduce tremors by temporarily paralyzing the muscles.
• Physical therapy and rehabilitation: Physical therapy can help strengthen muscles, increase flexibility, and improve posture, all while helping to control tremors.
• Lifestyle changes: Stress and fatigue can trigger or worsen tremors. A healthy lifestyle, including adequate sleep, regular exercise, a healthy diet, and avoiding stress, can help manage tremor symptoms.

The treatment approach is customized based on the patient's tremor type, symptom severity, and individual health status. Treatment for tremor requires an individualized approach and should be determined in collaboration with the patient's physician.

How to alleviate tremor?

Tremor may not be completely cured, but lifestyle changes and certain methods can help alleviate symptoms. To reduce the effects of tremor, you can:

• Physical, speech, and occupational therapy: Physical therapy can help improve muscle strength and control. Speech therapy can strengthen your voice and communication. Occupational therapy can offer suggestions to make activities of daily living easier.
• Caffeine reduction: Caffeine can increase jitters, so reducing or eliminating coffee, tea, and energy drinks may help relieve symptoms.
• Specialized utensils: You can eat more comfortably by using specially designed utensils like plates, forks, and spoons. These utensils can make your daily activities easier.
• Regular use of medications: If your doctor has prescribed medication, taking your medications regularly can help keep symptoms under control.
• Managing stress: Stress and anxiety can worsen tremors. It's important to reduce stress through relaxation techniques, such as meditation, deep breathing, or yoga.
• Easy to wear: You can make dressing easier by choosing zippered or laceless clothing instead of buttoned clothing.
• Sleep and physical activity: Getting enough sleep supports your overall health and can reduce tremor symptoms. Light exercise can strengthen muscles and help balance the body.
• Social support: Getting support from family and friends can help you cope with tremors.

It's important to remember that each individual's situation may be different. The symptoms and effects of tremors can vary from person to person, so it's best to take a personalized approach based on recommendations from a specialist.