Parkinsonian Tremors

What are Parkinsonian tremors?

Parkinsonian tremors are slow, rhythmic, shaking movements. They are most obvious and bothersome when your hands are at rest. These kinds of movement are linked to the brain disorder called Parkinson’s disease.

How do they occur?

Parkinsonian tremors happen when your brain does not have enough of a substance called dopamine. Without enough dopamine, you cannot control your movements normally. Known causes of these tremors include some drugs, carbon monoxide poisoning, and some kinds of brain infections.

What are the symptoms?

At first, tremors occur as a rhythmic back and forth motion of the thumb and forefinger. It looks like you are rolling a pill between your fingers and thumb, so healthcare providers call it the pill-rolling tremor.

Tremors usually start on one side of the body. They may affect more of the body as the disease progresses. Parkinsonian tremors can affect all parts of the body, including the lips, tongue, and jaw, though they rarely affect the entire head.

Parkinsonian tremors are called resting tremors because they occur when the muscles are at rest. They stop when you deliberately do something such as move or change position.

How is it diagnosed?

There is no special test for Parkinson's disease. The diagnosis is based on the symptoms, medical history, and a physical exam. A resting tremor or pill-rolling tremor strongly suggests Parkinson’s disease. Other types of shaking or tremor are not necessarily symptoms of Parkinson’s disease.

How is it treated?

Tremors can be treated with levodopa or other medicines. With treatment the tremors may be reduced or may go away completely. Most people who have Parkinson’s disease, and healthcare providers with experience managing Parkinson’s disease, think that the other symptoms are more important—that is, the rigidity and inability to move well. Treatment decisions are based on what is most disabling for each individual. Usually the tremor is a nuisance but not the biggest problem of Parkinson’s disease.

Parkinson’s disease may also be treated with brain surgery. The earliest type of successful brain surgery was done by destroying small parts of the brain. This is called a pallidotomy. Surgery to stimulate a slightly different part of the brain has become more common than the pallidotomy surgery.

What can I do to take care of myself?

• Observe how your body responds to the medicine you take for your condition. For example, are there times of day when your tremors are worse? Overall, are your symptoms getting worse or better? Are you having any problems with your medicine? Share this information with your healthcare provider.
• Learn as much as you can about your condition.
• Focus on staying active, even though it may be hard to do some things.
• Be aware of safety issues if your tremor is not well-controlled. Examples include cigarette hazards and the dangers of handling hot liquids.