How do you stabilize a trembling hand?

When muscles are shaking: identifying the causes of tremors

Status: 01.12.2020 8:34 a.m.

Trembling is completely normal when you are afraid, excited or cold. But muscle tremors can also indicate a disease of the nerves - a so-called tremor.

In neurology, tremor is one of the most common symptoms. The tremor can occur at rest or in motion. Sudden, persistent tremors are always a reason to see a doctor.

Common causes of muscle tremors

Many people fear that Parkinson's disease is causing the tremors. But other diseases can also trigger a tremor, such as metabolic diseases such as an overactive thyroid, disorders in the cerebellum and multiple sclerosis.

With Parkinson's disease, those affected tremble, especially when they are at rest. As soon as they use their hand, for example holding a pen, writing or playing the piano, they hardly tremble anymore. In the so-called spiral test, however, they often draw the spiral smaller than the template. Unilateral tremor and other symptoms such as slowing down or waning facial expressions also indicate Parkinson's disease.

Tests for muscle tremors

Extensive diagnostics provide information on the causes of the tremor: a clinical examination, blood tests and images of the brain can rule out many diseases. The analysis of movements and muscle flows can also provide crucial information.

If no clear cause of the muscle tremors is found, doctors speak of a so-called essential tremor.

Essential tremor

In the case of essential tremor, areas of the brain that are responsible for controlling movements are overactive. The causes are unknown. Because the brain is less and less able to compensate for the overactivation with increasing age, the tremors slowly increase over the years.

In the case of an essential tremor, the hands are always affected first, but later the tremor can also spread to the head, voice and legs. People with essential tremor can often still keep their hands still in their lap at rest. But as soon as you move your hands, for example pouring coffee, holding a cup or drawing the spiral, the trembling becomes visible.

Treat essential tremors with medication

There is no targeted therapy for essential tremor because the cause is unknown. Various medications can suppress the tremors so that those affected are less affected in everyday life. The beta blockers propranolol and primidone or anti-epileptic drugs are prescribed particularly frequently.

Treat tremors with deep brain stimulation

Those who cannot tolerate the medication and suffer from very strong symptoms such as a trembling voice or head tremors can benefit from so-called deep brain stimulation. In this procedure, which has been established for two decades, electrodes are inserted into the areas of the brain that are responsible for the tremor in a surgical procedure.

A pulse generator implanted under the collarbone is connected to the electrodes via a cable and, like a cardiac pacemaker, sends pulses to the so-called thalamus. The brain region is responsible for the unconscious control of voluntary movements and is also responsible for the development of the tremor. The electrical stimulation can suppress the tremors.

Treat essential tremor with focused ultrasound

In the meantime, there is a new procedure in some treatment centers that can help with an essential tremor: precisely controlled, high-intensity ultrasound waves are bundled from several directions and directed onto a small point in the brain that is also responsible for the tremor. The heat generated at this point breaks the conduction and reduces the tremor. The procedure is considered to be very gentle and is particularly suitable for older people for whom brain surgery is no longer an option.

Experts on the subject

Experts on the subject
Prof. Dr. Jan Raethjen, neurologist
Preusserstrasse 1-9
24105 Kiel
(0431) 26 04 50-10
www.neurologie-raethjen-wasner.de
Dr. Jos Steffen Becktepe, senior physician
Day clinic for movement disorders, tremor clinic
Department of Neurology
University Medical Center Schleswig-Holstein - Campus Kiel
Arnold-Heller-Strasse 3
24105 Kiel
www.uksh.de

additional Information
German Society for Neurology V.
Reinhardtstrasse 27 C
10117 Berlin
dgn.org/leitlinien
Guideline "Tremor" for the diagnosis and therapy of the various forms of tremor

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