Parkinson's Tremors: An Overview

Parkinson’s Disease is a neurological condition that affects the brain’s ability to regulate bodily movements. It impacts coordinated movements and unfortunately, has no cure. However, treatment can keep symptoms under check and enable a more or less normal lifestyle. In particular, Parkinson’s tremor is the most common symptom of the disease which can interfere with daily activities. This article is an overview of Parkinson’s tremors and how patients can cope with it effectively.

Parkinson’s Disease is one of the most common neurodegenerative conditions in the world. It primarily damages the dopamine-producing neurons in a specific area of the brain called substantia nigra. Typically, around 50% more men than women are diagnosed with Parkinson’s Disease, with symptoms first manifesting at age 60 or older. The exact cause of Parkinson’s Disease is unknown, with many scientists postulating that certain genetic mutations may predispose people to develop the condition.

The most common symptom of Parkinson’s Disease is the tremor. This is an involuntary quivering or shaking of a body part. Tremors related to Parkinson’s typically start in the hands, arms, or jaw, and tend to stop when the affected body part is deliberately moved. For example, reaching out to shake hands. Tremors also stop when the patient is sleeping. They usually start in a single limb or one side of the body and worsen over time as the disease progresses. However, many patients may continue to experience tremors on one side of the body.

Certain types of Parkinson’s medication may enhance tremors. They also tend to intensify with stress. Living with Parkinson’s Disease tremors can be difficult as well as embarrassing, and patients may take efforts to conceal the hand or foot with the tremor in public. They also tend to appear when the patient holds their limb steady in one position, such as holding a glass or spoon to the mouth. This can lead to patients spilling during mealtimes.

Different people will experience Parkinson’s tremors in different body parts and with different intensities. The main types of Parkinson’s tremors include:

• Jaw tremor: This is one of the most common types of Parkinson’s tremors. This often looks like shivering, although it is slower. It does not manifest while chewing food. It can, however, cause teeth to grind together and may push dentures out of place. It may also cause a clicking noise and attract unwanted attention.
• Foot tremor: This is a resting tremor that shows up when the patient is lying down or sitting with their feet dangling. It typically manifests in the foot, although in some cases the thigh may also shake. The tremor, however, does not interfere with standing or walking.
• Finger tremor: Most Parkinson’s tremors will begin in the fingers. When they appear, it seems as though the patient is rolling a pill between the fingers, which is why this is also known as a pill-rolling tremor.
• Tongue tremor: In some cases of Parkinson’s Disease, the tongue may develop a tremor.
• Head tremor: This manifests in about 1% of Parkinson’s Disease cases, although in some cases it may be owing to tremors being transmitted from the arms.
• Internal tremor: Some patients experience Parkinson’s stomach tremors, which involves a shaking feeling in the abdomen that is not visible from the outside.

Tremors related to Parkinson’s are not debilitating, unlike other types of tremors. They tend to plateau after worsening for a while, and may even reduce or disappear on their own over time. Several medications have been demonstrated to be effective against tremors, although some come with their own side effects. It is important for patients to remember that medication cannot cure tremors completely, but can help combat frustration, when symptoms do not abate enough. Another treatment that physicians may recommend is deep brain stimulation, which is successful in about 90% of cases. In terms of lifestyle adjustments, stimulants like caffeine or alcohol can exacerbate tremors and should be avoided. Stress can also make tremors worse, so patients should consider managing it through yoga or meditation.

• What is the difference between essential tremors and Parkinson’s Disease?

In many cases, Parkinson’s tremor is confused with essential tremors. Both involve the head and the hands, and sometimes the jaw. However, essential tremors affect the vocal cords, which Parkinson’s tremors never do. Patients may sometimes experience both forms, which can make a diagnosis difficult.

• What do early Parkinson’s tremors look like?

Parkinson’s tremors tend to first appear on one side of the body, in a single limb, and then progress from there.

• What causes tremors in Parkinson’s Disease?

Parkinson’s tremors are chiefly linked to altered activity in the basal ganglia, substantia nigra, and the thalamus, owing to the dopamine depletion that occurs with the onset of the condition.

• Can Parkinson’s tremor disappear?

Parkinson’s tremors tend to be unpredictable, with some getting steadily worse, some plateauing after a certain amount of progression, and others reducing or even disappearing on their own. Generally speaking, medication can reduce the occurrence of tremors and ensure that daily activities are not affected too much.

• Is there any way to prevent Parkinson’s Disease?

There is no consensus on what causes Parkinson’s Disease, which means there is currently no way to prevent or cure it. Treatment can help keep the disease significantly under control.

• What foods should Parkinson’s patients avoid?

Parkinson’s Disease patients should adopt a diet that is rich in whole foods and fresh produce. Things to avoid include dairy products, canned fruits and vegetables, and foods high in saturated fat or cholesterol.

• What is the best exercise for Parkinson’s Disease?

It is recommended that Parkinson’s Disease patients engage in moderate exercise at least three times a week for at least 30 to 40 minutes. Both aerobic exercise (such as running, swimming, or biking) and strength training are effective for managing the symptoms and feeling healthier overall. Depending on the patient’s symptoms, the physiotherapist may recommend specific exercises to combat tremors to enhance gross and fine motor skills.

• Do all Parkinson’s patients have tremors?

Tremors occur in about 80% of Parkinson’s Disease patients.

While living with Parkinson’s Tremors can be embarrassing and annoying, they tend not to affect daily activities to a large degree. With proper physiotherapy and medication, the tremors can be kept under control and even cured for periods of time.

A highly regarded neurologist and stem cell specialist, Dr Na’eem Sadiq studied neurology and clinical neurophysiology in London before working with some of England’s and the Middle East’s most prestigious medical institutions. He completed his MBBS