Table of ContentsView AllTable of ContentsAction TremorsRest TremorsCauses and Treatments
Table of ContentsView All
View All
Table of Contents
Action Tremors
Rest Tremors
Causes and Treatments
Many conditions can causetremors—involuntary, rhythmic, or shaking movements of a part of your body. Understanding the cause and finding the proper treatment requires you to, first, identify the tremor. There are two main types of tremors: action tremor and rest tremor. These are further divided into subcategories and are described according to specific criteria.
A person may experience physiologic tremors, which means they are a normal reaction to a situation such as an arm shaking when you’re trying to hold it steady for a long period. You might also experience pathologic tremors, which means they are related to a medical condition such as Parkinson’s disease.
This article explains each of the categories used to identify tremors, the causes for these various types, and how to treat them.
Mint Images / Paul Edmondson / Getty Images
Action tremors occur when you intentionally move your muscles. They come in several types, which may overlap.
Postural Tremor
This type of tremor occurs when you try to keep a body part still against gravity (e.g. when holding your arms out in front of you).
Postural tremors can occur due to Parkinson’s disease, certain drugs, or a neurological disorder called essential tremor, among other causes.
Isometric Tremor
This type occurs when the muscles tense up against a stationary object, though the body is not moving. For example, your arms may shake during push-ups when you hold your position. Pushing against a wall or holding a heavy object can also cause isometric tremors.
Kinetic Tremor
This type occurs during voluntary movement. It has two sub-types:
Intention tremorsare most prominent during an act of coordination, such as pushing a button. An intention tremor occurs with movement but worsens when you get close to a target.
Unlike rest tremors with other causes, Parkinson’s disease rest tremors come with other symptoms, such as lower blink rate, small handwriting, and arm and leg stiffness.
Causes and Treatments of Different Types of Tremors
Tremors can occur due to many causes, including certain medications, anxiety, or low blood sugar. They can also be part of an underlying condition, such as essential tremor, dystonia, or Parkinson’s disease.
In all cases of tremor, the primary focus is on treating any underlying disorder as much as possible, rather than simply treating the symptom (the tremor itself). Your healthcare provider may prescribe specific medications. Physical therapy can be helpful as well.
In cases where medical and physical therapies have been insufficient, and the tremor remains truly debilitating, more invasive options, such as brain surgery ordeep brain stimulation, can be considered. As always, treatment options should be thoroughly discussed with your healthcare provider.
Physiologic Tremor
Everyone experiences physiologic tremor, though it usually isn’t very noticeable.It has a low amplitude (limited range of motion) and high frequency. You may have noticed it when holding hand out with your fingers extended. A physiologic tremor can occur at rest and during actions.
Physiologic tremor may become more noticeable (becoming an “enhanced physiological tremor”) due to anxiety, fatigue, stimulants like caffeine, fever, alcohol withdrawal, low blood sugar, some medications, and more.
Enhanced physiological tremor goes away when the underlying cause is corrected.
Essential Tremor
Essential tremoris a neurologic movement disorder that affects up to 6% of the population.Most often, it starts during adolescence or between 40 and 50 years old.Essential tremor often runs in families, but no single gene has been found to explain the disorder.
Essential tremor typically causes action tremors as a symptom, and hands are usually the most affected. It may show up with you spilling coffee or experiencing shaving injuries. In severe cases, you may experience resting tremors.
Mild cases of essential tremor may not require treatment. If your symptoms interfere with daily activities,several treatment optionsare available, such as medications, focused ultrasound (in a hospital setting), and deep brain stimulation.
To start, a healthcare provider will likely recommend medications. Several types can be effective, including:
Parkinsonism
If the cause of a Parkinsonian tremor isParkinson’s disease, it may respond well to Inbrija (levodopa) or otherdopaminergic medications.Other possibilities include amantadine and anticholinergic drugs.
Psychogenic Tremor
“Psychogenic” means the tremor has a psychological cause rather than an underlying physical condition. Psychogenic tremor may also be referred to as functional tremor.
Treating psychogenic tremor can be difficult. Cognitive behavioral therapy (CBT) is the recommended psychological approach. People may also benefit from relaxation techniques, physiotherapy, or transcranial magnetic stimulation.
Orthostatic Tremor
In orthostatic tremor, the legs and trunk start trembling soon after standing. Someone with orthostatic tremor may not notice a tremor so much as unsteadiness after standing up. It improves as soon as someone sits down. Treatment can be with either Klonopin (clonazepam) or Mysoline (primidone).
Drug-Induced Tremor
Many medications can cause tremors of some type, including certain stimulants, corticosteroids, antidepressants, antipsychotics, and others. Examples include:
Dystonia
Thetreatment of dystonia, as well as the associated tremor, is commonly done with injections of attenuated botulinum toxin.Klonopin or anticholinergic medications may also be helpful.
Cerebellar Tremor
Cerebellar tremor occurs due to damage to the cerebellum (the part of the brain responsible for balance while walking or standing) or its surrounding pathways to other brain areas. Cerebellar tremor typically shows up as an intention tremor with high amplitude and low frequency.
Cerebellar tremor frequently occurs in people with multiple sclerosis (MS).There are no FDA-approved medications for cerebellar tremor, but healthcare providers may prescribe medications such as Inderal (propranolol) or amantadine to help manage it.
Summary
Tremors can be divided into two main categories based on whether you’re activating your muscles or not. These categories are action and rest.
Depending on the type of activity you’re performing, action tremors can be postural, kinetic, or isometric. Some action tremors can occur in anyone, especially if you’ve had caffeine or are anxious or fatigued. Action tremors can also happen due to underlying disorders such as dystonia or essential tremor.
The treatment for tremors is focused on treating the underlying cause. You may be prescribed medications such as Inderal (propranolol) or Klonopin (clonazepam). In severe cases, surgery or deep brain stimulation may be recommended. Physical therapy or other non-medication approaches may also be helpful. Your healthcare provider can recommend the right treatment plan based on the severity and cause of your tremor.
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