Tremor is the process of involuntary shake of the body or its individual parts. It is regulated by the nerve impulses and the contractile ability of muscle fibers. Most often, Tremor acts as a symptom of pathological changes of the nervous system, but may be also an episodic character, arising after training or stress. Why is trembling arise, can it be controlled and when should you consult a doctor?
General characteristic of the status
Tremor is an involuntary rhythmic muscle contraction that a person cannot control. One or more body parts are involved in the process (most often occurs in the limbs, less often - in the head, voice ligaments, torso). Chaotic muscle contractions are most susceptible to patients of older age categories. This is due to the weakening of the body and the accompanying diseases. In general, Tremor does not represent serious danger to life, but significantly reduces its quality. A trembling can be so strong that it deprives a person the ability to raise small items or sleep peacefully.
Possible causes of development
In most cases, trembling is caused by injuries or pathological processes in the deep layers of the brain responsible for movement. Incoming abbreviations can act as a symptom of multiple sclerosis, stroke, neurodegenerative diseases (for example, Parkinson's disease). They can also indicate renal / liver failure or failure in the work of the thyroid gland. In medical practice, there is often a predisposition to Tremor, due to genetic factors.
Sometimes trembling does not indicate a disease, but is a protective reaction of the body to external stimuli. Among them is mercury poisoning, alcoholic intoxication, strong emotional stress. In this case, the tremor is short-term and disappears with the stimulus.
Jitter never occurs unfortunately. If you can not explain the origin of tremor or its intensity looks frightening - consult a doctor.
Classification of involuntary cuts
Doctors share tremor on 4 categories - primary, secondary, psychogenic and trembling in diseases of the central nervous system. Primary tremor arises as a natural protective reaction of the body to cold, fear, intoxication and does not require treatment. The remaining categories are a manifestation of serious diseases that need medical care.
Classification for the mechanism of occurrence
Shivery can develop in total in two cases - at the moment of activity or relative peace of muscles. Tremor actions (promotional) starts during an arbitrary reduction in muscle fibers. To the signal that the nervous system sends into the muscle, several additional pulses are connected, which cause trembling. The promotional tremor may be postural, kinetic and intentional. Postural trembling arises when holding poses, kinetic - at the time of movement, and intense - when approaching the target (for example, when trying to take something, touch the face / other part of the body).
The rest of the rest arises only in a relaxed state, disappears or partially dulled while driving. Most often, the symptom indicates progressive neurological diseases. As the disease, the amplitude of the oscillations slowly increases, which seriously worsens the quality of life and limits the functionality of the person.
Types of tremor
The main types of tremor include:
- Physiological tremor. Most often localized in the hands and is practically not felt by a person. It is short-term and arises against the background of anxiety, overwork, the effects of low temperatures, alcohol intoxication or poisoning by chemicals. Also, physiological jitter can act as a side effect on the use of potent drugs.
- Dystonic tremor. The condition is characteristic of patients with dystonia. In most cases, there arises against the background of dystonic postures and is gradually enhanced as the disease develops.
- Neuropathic tremor. Postural-kinetic jitter, most often caused by genetic predisposition.
- Essential tremor. In most cases, it is localized in the hands, is bilateral. Muscular cuts can cover not only hands, but also torso, head, lips, legs and even voice ligaments. Essential tremor is transmitted genetically. Often it is accompanied by an easy degree of krivoshei, muscle tone of limbs and spasm during the letter.
- Yatrogenic or medicinal tremor. It occurs as a side effect from the use of drugs or unskilled actions of the doctor.
- Parkinsonic tremor. This is the so-called "rest shake", which weakens at the time of movement or any other activity. The symptom is characteristic of Parkinson's disease, but may manifest itself with other diseases with Parkinsonism syndrome (numbers, with multisystem atrophy). Most often localizes in the hands, sometimes legs, lips, chin are involved in the process, less often - head.
- Cerebellar tremor. This is an intentional tremor, less often manifest as postural. In the process of trembling involved torso, less often - head.
- Tremor Holmes (rubred). The combination of involuntary postural and kinetic cuts, which occurs at the time of rest.
Features of therapy
Muscular cuts do not always need treatment. Sometimes their manifestations are so insignificant that a person does not feel special discomfort and continues to function in the usual rhythm. In other cases, the search for suitable treatment directly depends on the diagnosis.
How do tremor diagnose?
Diagnosis is based on the study of the history of the patient's disease, physiological and neurological examination. At the physiological survey, the doctor reveals the mechanism of development, localization and manifestation of tremor (amplitude, frequency). Neurological examination is necessary to compile a complete picture of the disease. Perhaps involuntary trembling is associated with a violation of speech, an increase in muscle rigidity or other deviations.
After the initial inspection, the doctor issues a direction to general urine and blood tests, biochemical blood tests. This will help to exclude metabolic factors for the development of tremor (for example, failures in the work of the thyroid gland). Subsequent diagnostic manipulations depend on the individual characteristics of the patient. For example, a specialist may assign an electromyogram (EMG). EMG is a method for studying muscle activity and muscle reaction to excitement.
In the injuries of the brain, we give a direction on CT or MRI, and with a strong jitter (a person cannot hold a handle / plug) - on a functional study. The patient is proposed to perform a number of exercises, according to which the doctor assesses the state of its muscles and the reaction of the nervous system to one or another task. Exercises are very simple - touch the tip of the finger to the nose, bend or raise the limb and so on.
Medical and surgical treatment
Essential jitter can be eliminated by beta blockers. The medication not only normalizes blood pressure, but also eliminates the load on the muscles. If the body refuses to respond to beta blocker, the doctor may prescribe special anticonvulsants. With other varieties of tremor, when the main treatment has not yet affected, and get rid of trembling need as soon as possible, tranquilizers are prescribed. They give a short-term result and can cause drowsiness, coordination violations and a number of unwanted side effects. Moreover, the regular use of tranquilizers may cause dependence. Also in therapeutic purposes, botulinum injections or high-indentional focused ultrasound can be used.
Do not self-medicate. Clearly follow the doctor's recommendations, do not change the specified dosages so as not to aggravate the position.
If drug treatment turned out to be ineffective, doctors apply surgical methods - deep stimulation of the brain or radio frequency ablation. What it is? Deep brain stimulation is a surgical procedure at which a pulsed device is introduced under the skin of the chest. It generates electrodes, sends them to the thalamus (deep brain structure responsible for movement), due to which the tremor eliminates. When radio frequency ablation, the nerve of the Talamus is heated, which is responsible for involuntary muscle contractions. The nerve loses the ability to generate momentum at least 6 months.
Tremor does not apply to the category of deadly states, but can significantly affect the quality of life. Daily routine actions, like washing dishes, eating, set of text, cause difficulties or not at all. Additionally, Tremor limits social and physical activity. A person refuses to communicate, familiar employment to avoid embarrassing situations, embarrassment and other things.
The medical outlook depends on the root cause of rhythmic cuts, their varieties and individual characteristics of the body. For example, the manifestations of essential tremor can enhance with age. Moreover, there is evidence of the connection of involuntary tremors with an increase in the risk of developing other neurodegenerative states (for example, Alzheimer's disease). Physiological and drug tremor are easily treatable, therefore, in their respect, the prognosis is favorable, but it is much more difficult to eliminate the hereditary factors. The main thing is to consult a doctor in a timely manner and proceed to therapy.
Tedeeva Madina Yipanovna
Specialty: Therapist, radiologist, nutritionist .
Common experience: 20 years .
Place of work: LLC "SL Medical Group" Maykop .
Education: 1990-1996, North Ossetian State Medical Academy .
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Tremor is the movements of various parts of the body of a jitter, arising regardless of the will of the person. In the overwhelming majority of cases, the patient is disturbed by the oscillations of the upper extremities, as well as legs, neck, or the entire body. Tremor detect both independent disease and as a manifestation of another disease.
Due to the difference in manifestations in the clinical picture of the disease, the tremor of peace and movement is distinguished. The rest of the rest arises in the muscles of the limbs and the torso, which at the moment do not fulfill work. Tremor movement appears during the commission of targeted movements. Tremor movement, in turn, is the following types:
- Postural. Appears when trying to support a defined posture. Most often manifested by trembling elongated hands in the standing position.
- Intense. This type of tremor appears when performing movement with a certain goal - to take a mug, clean your teeth, put a signature. It is characterized by the strengthening of tremor as it moves to the task and especially after the completion of the movement.
- Kinetic. It appears only at the end of the focused movement.
Tremor is not always a pathological, that is, indicative of the presence of some disease. Separately, physiological tremor is isolated - oscillatory movements of various parts of the body when exposed to any external factors. Such factors can be: an increase in body temperature, excessive consumption of coffee, fatigue, smoking, reception of some medicinal substances, supercooling, physical activity, alcohol cancellation syndrome, alarming and panic states, poisoning with various eradicates, hypoglycemia and thyrotoxicosis. This type of tremor can be revealed if the patient's attention can be distinguished. Usually, it is enough to ask him to fulfill some test so that Tremera is much weaker or disappeared at all. Physiological tremor manifests itself in the type of intentional or postural jitter.
Physiological tremor passes through a short period of time after provoking factor has been eliminated. In some cases, it may be necessary to replace drugs that take the patient, adjusting the hormonal background, work with a psychotherapist.
As a symptom, the tremor happens with various neurological diseases. These include: Parkinson's disease, sclerosis, stroke, brain tumors, meningitis, peripheral neuropathy. To reduce the manifestations of Tremera in this case, the main disease will be treated. Such a disease of exchange as Wilson-Konovalov's disease (violation of copper exchange in the body) will also be accompanied by tremor. In the elderly and old age, the main cause of tremor is Parkinson's disease.
Tremor also exists in the form of an independent disease. This condition is called essential tremor. It is manifested mainly in the form of an intentional and postural tremor. Essential Tremor has a detected genetic predisposition to development and is not associated with any external factors. It manifests itself in the form of oscillations of fingers and hands, especially when they are committed by targeted movements. In the late stages of the disease, along with the trembling of the upper limbs, you can observe the characteristic movements head - nodding or turns of the head to the side (symptom of "yes-yes" and "no-no"). Often, Essential Tremor has a favorable forecast, with it rarely observed memory violations, thinking and orientation in space and time.
The main symptom of the disease most often distinguished trembling in the hands, which appears when moving or attempts to keep a certain pose.
Tremor usually occurs in two hands immediately, or first in one, and after a while - no more couple of months, and in the second. When delayed the development of tremor in one hand, the difference of the amplitude of the jitter may occur, so the tremor will be asymmetrical. Tremor initially develops in the fingers, later they are connected to the brushes of the hands, forearm and shoulders, then the jitter applies to the head, in some cases and on the body. Characteristic of patients with tremor will be a violation of speech, due to the damage to the nerves controlling the lads.
Due to the development of tremor, patients experience difficulties in familiar daily activity. They are limited to the possibility of independent meals, dressing, carrying out any hygienic procedures. The development of tremor is a threat to continuing work.
Kinetic tremor in the hands arises with a variety of movements, so it becomes impossible to perform even the most banal actions for the patient. They only can pour a glass of water with great difficulty and drink from it, use cutlery, handle and pencil, toothbrush. Kinetic tremor in hands is manifested by involuntary bending and extension of fingers, brushes, forearms. With postural tremor, trembling is less pronounced. If the tremor arose against the background of the development of Parkinson's disease, the trembling will be characterized by the type of "swirling light bulb".
In the later stages of the disease, voice ligaments, muscles of jaw, language, lower extremities can be amazed. Voice changes against the background of essential tremor rarely takes up to 60 years.
About a third of patients with tremor have disorders when walking, which manifests themselves erroneous side steps. The dependence of the walking disorders from the age of the patient, the presumption of the disease and the force of the severity of the tremor of the upper limbs is observed.
A neurologist is engaged in the examination and treatment of patients with Tremor. When collecting anamnesis, try to find out how long and with what force the tremor appeared on which parts of the body. Separate attention is paid to provoking factors if the patient can be allocated. With a sudden appearance of tremors, it is necessary to find out if the head injury was previously in the life, did not begin the patient a new drug.
The neurological examination necessarily includes an assessment of cognitive functions, the functions of the cranial nerves, movements, sensitivity, gait, position in the pose standing stretching hands with eyes closed, strength and tone of muscles, reflexes.
For a reliable diagnosis of essential tremor, a number of criteria were revealed. According to them, in order to diagnose essential tremor, the patient should have a bilateral tremor movement of the upper limbs throughout at least 3 years, as well as there are no other neurological symptoms.
Essential Tremor is a diagnosis of exception, that is, it is exhibited only when all possible diseases provoking this symptom have been discarded. Differential diagnosis is carried out with such diseases of the nervous system as: Parkinson's disease, sclerosis, stroke, brain tumors, meningitis, peripheral neuropathy, brain abscess, alcoholic delirium, as well as Wilson-Konovalov disease and hyperthyroidism.
With weak manifestations of tremor when it does not bother the patient, treatment is not conducted. With the fact of physiological tremor, the main recommendation will avoid provoking factors: stress, smoking, overwork, abuse of coffee, alcohol, cancel drugs. Also, with a physiological tremor, which causes an anxiety in a patient, a course appointment of medicines is possible.
The diagnosed essential tremor requires a long appointment of drug therapy with a dose selection. Treatment, in the first stages, occurs in stationary conditions, after which the patient is observed at the neurologist outpatient.
Symptomatic tremor arising against the background of Parkinson's disease, lesions of the nervous system or other diseases, serves as an additional factor for high-quality therapy of the underlying disease. In this case, a comprehensive approach to treatment is necessary, which will be directed to the same extent, both on the factor in the development of tremor and on all symptomatic manifestations.
For the treatment of tremor, the physical activity of the suffering limb of weighing and tension during the movement of the muscles, located closer to the body can be useful.
If the tremor of severe degree does not give in to medicinal treatment, the use of surgical treatment methods is justified. By means of neurosurgical intervention, there is an impact on different parts of the brain, controlling passive movements and muscle tone. Often, this practice is very effective, but a prerequisite for its application will be preserving the mental and mental functions of the patient. Neurosurgical intervention is also effective in Parkinson's disease.
In the first appeal to the doctor and low-heed symptoms, drugs may not be required. It is sufficient to calm patients and appoint weak sedative pharmacy preparations (Corwalola, hawthorn tincture, Valeriana).
For the treatment of manifestations of physiological tremor and chronic anxiety, drugs of benzyldiazepine groups are used (diazepams, lorazepam, oxazepam). Such drugs are prescribed by a short course, from 2 to 4 receptions during the day. Effective in the fight against tremor arising from the reception of drugs are beta blockers (propranolol, bisoprolol, metoprolol), which are also helping with rare episodes of increased anxiety.
For the treatment of essential tremor, a combination of a beta-blocker of propranolol and the anti-kvulsant of the prison is prescribed. Such a combination of drugs is the most efficient and safe for a given disease. If, after a certain time it becomes clear that the tremor does not pass at the reception of these drugs, they are added at the discretion of the doctor Alprazolam, Atenolol, Satolol, Topiramat or Gabapentin.
Tremor caused by Parkinson's disease is successfully treated with levodopa. Sometimes it is possible to prescribe anticholinergic group preparations (VECURIONIONIONION, PIPECURINIONIONIONIONION, Dioxonium), but often side effects in the form of dry mouth, reduce concentration, urine delays and chairs, dry eye syndrome prevail over possible effects from treatment.
Folk remedies are perfectly coped with physiological tremor, which is caused by stress and physical overwork. To improve well-being after loads and reducing the manifestations of excitement, you can use the following methods.
- Decoration from oats. Prepared immediately to the entire course of reception. For one liter of water you need to take 100 grams of oats, boil and insist overnight. In the morning, on an empty stomach drink one glass. So continue 5 days, after which it is necessary to take a break. Repeat the reception in a week if the attacks have not passed.
- Decorations of therapeutic herbs. To combat tremor and anxiety, tea with the addition of Valerian, heather, chamomile, mother-in-law are perfectly suitable. If possible, brew grass in the thermos and let it stand for at least an hour. On a glass of water take one tablespoon of dry grass. The recipe is good in that it is possible to consume herbal decoction daily.
- With frequent tremor, you can use the juice of the flowers of the Pijmas. Juice of 2-3 flowers squeeze into a glass with water, or just to warm up, but not to swallow the flesh.
For comfortable relaxation, hot tubs with essential oils and herbs are excellent. It is recommended to take a bath before bedtime, adding several tablespoons of lavender essential oil, mints, or other soothing plants, or a couple of glasses of bravery valeriana, heather, chamomile, mother-in-law, Melissa.
Well helps to relax after severe physical massage. Even the unprofessional massage of the main muscle groups of the back, the upper and lower extremities favorably affects the circulation of blood, helps to relax and remove fatigue.
Information is referenced and is not a guide to action. Do not self-medicate. At the first symptoms of the diseaseContact your doctor
Your comments on symptoms and treatment
Tremor (Lat. Tremor - trembling) -
a) Quick, rhythmic, with a frequency of about 10 Hz., The movement of the limbs or torso caused by muscle contractions and associated with the time delay adjusting afferent impulsation, which is why the implementation of movement and the preservation of the posture occurs due to a constant adjustment of movements to some average value . With tensile and strong emotions, as well as in the pathology of the nervous system, the tremor is significantly enhanced. In particular, the pathological tremor (the tremor of rest) is observed in Parkinson's disease.
b) Fixing eye movements with high frequency and low amplitude.
- Tremelor rest - arises in the muscles in the state of relative rest.
- Tremor Action (Action Tremor) - arises with arbitrary muscle contraction.
- Postural (permanent) tremor - occurs when holding poses (for example, tremor elongated hands).
- Kinetic tremor - occurs when driving.
- Intentive tremor (from lat. Intentio - intention) - occurs when approaching the goal (for example, an attempt to get a finger into the nose).
- Physiological and enhanced (accentuated) physiological tremor.
- Essential (family and sporadic).
- Parkinsonic tremor in Parkinson's disease and Parkinsonism syndrome.
- Cerebellar (cerebellar).
- "Rubnaya" (average-creation).
- Yatrogenic (drug induced).
Types of tremor
Physiological tremor - It is mostly fast tremor, appearing in the hands or other part of the body (lips, neck, etc.) is usually not felt by a person. The accentuated tremor may occur against the background of anxiety, fatigue, supercooling, alcohol abstinence, thyrotoxicosis, pheochromocytoma, hypoglycemia, mercury poisoning, lead, arsenic, carbon monoxide, as well as under the action of a number of drugs.
Treatment includes the impact on the underlying disease, avoiding provoking factors (such as coffee or tea).
Essential Tremor. - This is a postural and kinetic tremor, usually most pronounced in their hands, more often than bilateral, although sometimes asymmetrical is hereditary. Together with the hands, the head, voice ligaments are often involved.
Parkinsonic tremor - This is a quiet of rest, weakening when driving, but amplifying at rest when walking and distracting attention. Particularly characteristic of Parkinson's disease, but may also appear with other diseases that are manifested by Parkinsonism syndrome, such as multisystem atrophy. Especially often occurring in their hands, sometimes legs, chin, lips, but extremely rarely - head is exclusively. It is often asymmetrical and can remain unilateral for quite a long time.
Cerebellar tremor - This is predominantly intense tremor, but sometimes, especially with multiple sclerosis, there is also a slow postural tremor, involving the body and proximal limbs, sometimes a head.
Rubred (Mezentcephalus) tremor or tremor holmes - This is a combination of postural and kinetic tremors with the Tremelor of People ("Tremera Tremera"). This type of tremor most often occurs when the middle brain is defeated, less often - Talamus.
Dystonic tremor - observed in patients with generalized or focal dystonia and is a focal, asymmetric tremor; Often it occurs against the background of dystonic postures and enhances when trying to resist the tonic hyperkinosis, but decreases under the action of corrective gestures.
Neuropathic tremor - This is a postural-kinetic jitter, often occurring under polyneuropathy - hereditary motor-sensory neuropathy I type (neural amyotrophy of the Charcot-Marie-Tuta), chronic inflammatory demyelinizing polyradiculoneuropathy, dispensenemic polyneuropathy, less often with diabetic, uremic and porphyneuropathy.
- D.R. Stlimman, O.S.levin. Neurology. Handbook of a practical doctor. // M. "Medpress", 2008.
- Golubev V.L., Vane A.M. Neurological syndromes // M. Medpress-Inform, 2007.
|Headache||Migraine • Clustered headaches • vascular headache • voltage headache|
|Sleep disorders||Insomnia • hypersmannia • apnea in a dream • narcolepsy • kataplexia • Klein's syndrome - Levin • Distribution and waking cyclicity|
|Motor and motor disorders|
Discinesia: Dystonia • Chorea • Mioclonia • Unferricht's disease - Lundborg • Tremor (Essential Tremor, Intente Tremor) • Restless Foot Syndrome • Muscle Station SyndromeBasal Ganglia diseases: Parkinson's disease • Neuroleptic syndrome • Pantotenteente-associated neurodegeneration • Progressive supervising paralysis • Straitonigital degeneration • Hemibalism
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|Cerebrovascular disease||Transient Brain Circulation Disorders (Hypertensive cerebral crisis, transient ischemic attack) • Encephalopathy (Cerebral atherosclerosis, subcortical atherosclerotic encephalopathy, chronic hypertensive encephalopathy) • Stroke (Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) • Sinus thrombosis solid cerebral shell (Cavernous sinus thrombosis)|
|Inflammatory diseases||Abscess brain • Meningitis • Arachnitis • Encephalitis • Meningoencephalitis • Encephalitis of Rasmusten • Tick Encephalitis|
|Demyelinizing diseases||Autoimmune diseases (Multiple sclerosis, optomyselitis, spotter disease) • Hereditary diseases (Adrenoleykodistrophia, disease krabbe) • Central Pontane Melinoliz • Markiaphy syndrome - Binia • Alpes syndrome|
|Systemic atrophy||Peak Disease • Huntington's Disease • Spinal AttacksPinal Muscular Atrophy: Kennedy Syndrome • Spring Muscular Atrophy in Children • Motor Neuron Disease • Fazio-Londe Syndrome • Side Amiotrophic Sclerosis|
|Mitochondrial diseases||Leia syndrome|
|Tumors||Brain Tumor • Tuberous Sclerosis|
|Spinal fluid||Intracranial hypertension • brain edema • intracranial hypotension|
|Injuries||Brain-brain injury (Concussion brain, brain injury, diffuse axonal brain damage)|
|Other diseases||Spinal Grooming • Reya Syndrome • Liver Coma • Toxic Encephalopathy • Hematosylia|
|Inflammatory diseases||Meningitis • Arachnoidite • Meningoencephalitis • Mielitis • Poliomyelitis • Demyelinizing Diseases • Tropical Paraperex|
|Other diseases||Siringomyelia • Siringobulbia • Morvan syndrome • Vascular myelopathy • spinal stroke • spinal cord compression • Encephalomyelitis|
Tremor is rhythmic, fast contraction of the muscles of the body or the limbs of an involuntary nature. Literally The term tremor muscle means "jitter". Cooking can occur during peace or exclusively with arbitrary movement. Muscle tremor allows you to perform a coarsest job. Often, the actions associated with small motility are difficult. So, for example, it is often difficult to hover in the ear of the needles thread or significantly spoil the handwriting. Supplement, fatigue, increased concentration of attention, excessive muscle tension usually enhance trembling. Most often, the described violation strikes the upper limbs, less often proximal parts of the body. The tremor is most susceptible to people of age categories, but may be born and at a fairly young age.
Causes of tremor
Before finding out the factors that cause involuntary muscle cuts, it is necessary to answer the question: "Tremor, what it is."
The tremor is involuntary rhythmic reductions in muscle groups of certain parts of the body. More often a jitter is a signal of any problems arising in the body, and not a separate ailment.
Incoming muscle contractions can be a symptom associated with dysfunction of brain areas controlling muscles. In addition, trembling may occur due to a number of neurological disorders, such as sclerosis, stroke, cranial injuries, and some neurodegenerative diseases that are destroyingly affecting certain brain or cerebellum zones, for example, Parkinson's disease.
There are also a number of other factors provoking the development of body shakes and limbs:
- atherosclerosis of the vessels of the brain (due to the accumulation of cholesterol plaques on the walls of capillaries there is a narrowing of arterial vessels), leading to the development of chronic pathology of cerebral circulation;
- Minouri disease or essential tremor, which is a hereditary benign disease and manifested by an imperative jitter, more often the muscles of the neck;
- thyroid dysfunction, causing increased hormone production (thyrotoxicosis) and other pathologies of the endocrine system;
- abuse of alcohol-containing drinks;
- acute circulatory breakdown in the brain, especially in a section with blood cerebellum;
- tumor processes, abscesses in cerebellar;
- Degenerative disorders (olivopontoantocellar degeneration): a group of parables with an unknown etiology, leading to gradual dieting cerebral cells;
- Wilson-Konovalov disease, which is a hereditary pathology, the essence of which is in violation of copper metabolism;
- side effects of some drugs;
- liver or renal failure;
- poisoning toxic substances;
- narcotic breaking;
- depressive states;
- a sharp decrease in blood levels of sugar, the so-called hypoglycemia that occurs during diabetes.
In addition, a tremor is often observed with excitement, emotional overvoltage and physical fatigue. This is the so-called physiological jitter.
Symptoms of tremor
To find out the symptoms of tremor, it is necessary to determine the tremor, which is it and its forms.
As it was written above, the trembling is most often a symptom of the alend, and not a separate violation. It is manifested in the form of involuntary rhythmic muscle cuts. Two main varieties of this condition can be distinguished: pathological trembling and physiological. The first - arises due to serious dysfunctions of some parts of the nervous system.
Pathological tremor is one of the symptoms of the disease. The second is a slight shake, arising under certain conditions in the elongated upper limbs. This state usually takes place quite quickly after eliminating the cause. Such reasons include: excessive physical exertion, various stress factors, use of some medicines, etc.
One of the varieties of physiological trembling is tremor with excitement. The appearance of involuntary muscular reduction with excitement is quite a frequent phenomenon that can manifest itself differently. Most often, he comes from a stressful situation or depressive state. The trembling with excitement is manifested by twisting the brushes and fingers, head, limbs or larynx. This type of trembling with excitement is just a response of the body on anxiety, excitement and usually passes independently.
If the jitter is observed for several weeks, if it is not associated with the reception of medicinal substances, physical activity, stress, excessive alcohol use, that is, the likelihood that muscle contractions are caused by serious pathologies in the functioning of the body.
You can also classify trembling in its prevalence - local and generalized jitter. The first is observed in separate sites of the body (language, head, limb). Generalized muscular abbreviation is evenly distributed throughout the body.
According to amplitude, trembling can be divided into the following forms: finely durable and large-scale.
According to the features of the manifestation of tremor, it is possible to classify a static and dynamic form. The first form is a quiet of rest, since this form is observed and the most manifested muscle. The second form is a variable jitter, manifested or reinforced with active movements. It, in its turn, is postural, intentional and reduction. Postural jitter arises or exacerbated while maintaining any position (for example, holding out the straightened hands). Intentive muscular reduction appears when performing small accurate movements (for example, the tip of the finger touch the nose).
The reduction tremor occurs either aggravated when the muscle is kept in the abbreviated state (for example, long-term compression of the fingers in the fist).
Body tremor often occurs when abuse of alcohol-containing drinks or chronic alcoholism and is called alcoholic. The described variety of trembling is manifested by the "shaking" divorced fingers, often distributed on the head or body of the individual. This symptom is more often observed in patients in the morning and passes after the next use of alcohol-containing liquids. The same situation is also noted in drug-dependent individuals with an abstineent syndrome.
When using narcotic substances or incorrect reception of some drugs, an irregular finely discontinued trembling in the fingers or hands is noted. To eliminate this symptom, it is necessary to stop taking the drug.
Postural tremor is inherent, mainly to people suffering from vegetative dysfunction, are overly disturbing and concurrent individuals. This form of illness can be a consequence of the pathologies of the thyroid gland, the reception of a number of drugs and alcoholic beverages, and may also have hereditary roots. This form of tremor causes abstinence, poisoning by chemicals.
The postural tremor is small and more pronounced when the hands are elongated, and the fingers are spread. It is enhanced when attempting to concentrate attention when the individual tries to reduce the jitter, and when moving does not disappear.
Intended oscillation arises due to the defeat of the brain or cerebellum barrel. With this shape of trembling, large-sighted muscle contractions are noted, missing at rest, but arising from targeted movements, especially when the goal is reached. The patient, being in a position standing with her eyes closed, straightened and elongated with their hands, is not able to touch the nose.
This shape can cause tumor processes in the body, injuries, Konovalov-Wilson disease, vascular diseases, sclerosis.
The tremors of the muscles of the hands generated by the lesions of the cerebellum, the pathologies of the embedded structures and the brain stem is in constant.
The most dangerous variety of involuntary muscle oscillations is asterixis. His distinctive feature is in squeaming, arrhythmicity, asymmetric contractions. A trembling resembles flaking wings. This form is observed exclusively with arbitrary muscular voltage.
The described variety of trembling is due to periodic paroxysmal decrease in muscle tone responsible for maintaining a certain poses. That is why externally asterixis resembles a nehydramic, clapping jitter, which appears when the brush is extension and straightening the hand. After a few seconds, after straightening the hand, there are sharp shakes with a further instant return to the previous position. Similar twitches are detected with the tonic voltage of other muscles.
Often you can observe bilateral asterixis, which appears against the background of a vague consciousness. This is the main sign of metabolic encephalopathy. One-sided asterixis often occurs when stroke.
Rhythmic myoclonis is characterized by the smearing of the shake of the entire body, which is enhanced with muscle tension (when driving) and completely disappears when muscles relax. This shape of the jitter is often a satellite of the following ailments: various pathologies of the brain and vascular diseases, Wilson's disease, multiple sclerosis.
Parkinsonic tremor is a consequence of the defeat of the subcortex sections of the brain. In Parkinson's disease, trembling is characterized in a state of rest, disappearing or significantly decreasing with the beginning of actions.
Parkinsonic muscular tremor is more commonly asymmetric. This is manifested in the different intensity of trembling, for example, the left hand shakes more than the right. In this case, the oscillation decreases either completely disappears if the individual tries to make a spontaneous effect by this hand. With Parkinsonism of the movement, slowed down, but clearly.
Family tremor is caused by hereditary predisposition or as an essential tremor is also called it. Most often, he is observed in the elderly individuals, less often in children. This type of trembling more often appears when you try to keep a certain position. For essential trembling, fluctuations in small or medium amplitudes with unchanged muscle tone. Twitching is preserved, but is not exacerbated by flexing the upper limbs without support. A shiver at rest is observed much less frequently than in Parkinson's disease.
Essential tremor is considered the most common form of the considered aless. Often it meets with several family members. It manifests itself with jitter when performing any action. In other words, Tremor occurs at the tension of muscles and movement of hands. Twenty-five percent of cases of involuntary muscle contractions can join a lightweight degree of krivoshei, a letter violation (writing spasm), a slight increase in the tone of the muscles of the hands, which never exacerbates to the level of rigidity characteristic of a number of diseases, for example, Parkinson's disease.
Family tremor is considered one of the most frequent heredity of the nervous system.
Essential tremor during sleep is more pronounced. In addition, its manifestations are exacerbated when the individual increases the physical exertion on the upper limbs, for example, when writing or buttoning buttons. That is, with a shallow motor. Often after a while, it leads to difficulties in performing everyday tasks. For such people, auxiliary devices have been developed to help perform an ordinary work. For example, special handles have been developed for the letter, for fastening buttons Other specifical native focus instruments.
Strengthening the intensity of essential jitter can use alcoholic beverages or emotional stress. In addition, family tremors can often be accompanied by other neurological pathology, causing other forms of tremor.
Scheduling tremor or average-seed is observed in the dysfunction of the middle brain due to stroke, cranial and brain lesion, less often, with a demyelinizing or tumor process in the brain. It is characterized by a combination of the following forms of trembling: tremor in the state of muscular relaxation, postural tremor and pronounced intentional oscillation. This form of tremor is found in the limbs opposite to the zone of damage to the midbrain.
One of the variations of psychogenic motor pathologies is psychogenic tremor. The clinical criteria for this shape of jitter include a sudden beginning, wave-like or static, not progressive course. In addition, psychogenic twitching is characterized by the presence of spontaneous remission or remissions caused by psychotherapeutic treatment, the complexity of muscle contractions (equal degree of severity, all major forms of tremor may be observed), placebo efficiency.
It aggravates the course of the disease under consideration of any form abuse of drinks containing caffeine, alcohol-containing liquids, mental overvoltage, thyroid dysfunction, transitional period.
At the heart of any answer to the question: how to treat tremor? It is a high-quality and competent diagnosis that determines the form of tremor and factors provoked its development. Since the choice of therapeutic agents depends on the reasons that have brewed tremors.
The diagnosis of the ailment, which threatened the jitter, is often a rather complicated task, which is possible only subject to an accurate description of clinical manifestations.
Hence, the most important principle in the formulation of the diagnosis is a clear distinction between the three types of tremors, namely, trembling in the state of muscular peace, intente and postural tremor. For example, having revealed from one patient a combination of these three varieties of tremor, it is necessary to describe them and register as separate independent forms. At the same time, it is necessary to highlight the relative severity of each of the above varieties. For example, a patient may have a coarse tremor in a relaxed state, a less pronounced postural muscular reduction and an even less manifest intended jitter. A similar picture is typical for the shaking forms of Parkinson's disease. The same components of tremor outside the borders of Parkinson's disease are usually characterized by a different ratio - prevails either postural muscular abbreviation (inherent in severe Family Tremor), or the intentional (occurs during cerebellum pathologies).
Other significant principles describing trembling and helping to establish a correct diagnosis, which leads to the definition of tactics, how to treat tremor, the following: Localization, motor pattern of oscillations, amplitude-frequency properties, the syndromal environment of tremor.
A trembling can be localized at different parts of the body: on the upper or lower limbs, head, lower jaw, language, lips, neck, etc. Also, for competent diagnostics, it is necessary to take into account the distribution features (local or generalized, in hemitep) and other topographic features (for example, muscular reduction of the abdominal wall, twitching eyeballs, orthostatic tremor, proximal oscillation accentuation, symmetry / asymmetry).
To the parameter, the motor pattern can be attributed to the following characteristics: flexosis-extension, flapping, pronation-supination, etc.
The amplitude-frequency parameter includes the severity of oscillatory movements, the features of the flow of trembling (beginning and dynamics).
The syndrome environment of the jitter is a description of all neurological symptoms that accompany tremor.
Compliance with the foundations of the diagnosis of jitter will help to choose adequate therapy.
How to get rid of tremor?
To get rid of essential trembling, the appointment of the following medicinal substances is practiced: benzodiazepines, beta adrenoreceptor antagonists and prison. Beta-adrenoblasts are considered as effective as efficient, aimed at reducing the amplitude of oscillations. The minimum doses of benzodiazepines are also able to reduce the severity of family tremor. They can be used as monotherapy or in combination with beta-adrenoblockers. It is recommended to apply these drugs by courses, because over time, insensitivity can develop.
Medicase effect on cerebellary trembling is often ineffective. An effective approach to heavy cerebellery tremor therapy is considered to be the microstimulation of the Talamus or stereotactic thalamotomy.
Propanolol is effective in the treatment of alcoholic shaking arising after hangover. Patients in young age are often additionally prescribed medicinal substances of a group of beta-blockers, since they are effective at elevated pressure. Elderly patients who have alcohol addiction is in the running stage, it is recommended to assign a prison, since it does not have side effects on the cardiovascular system.
Treatment of trembling caused by Parkinson's disease includes the reception of drugs like dopamine (pergolid, ropinirol). It should be taken with great care, because the following manifestations can be generated: Late Discinesia, Clonus and Psychosis. It is also recommended an appointment to reduce the severity of parkinsonical tremors of anticholinergic drugs (benzatroin) and amantadine.
Patients with rubry twitching relief can bring anticholinergic preparations or levadopes.
In addition, people interested in response to the question: how to get rid of tremor, can take advantage of the secrets of traditional medicine. However, any independent getting rid of the painful symptom is recommended to be started under the control of specialists.
Author: Psychoneurologist Gartman N.N.
Doctor of the Medical and Psychological Center "Psomed"
The information presented in this article is intended solely for familiarization and cannot replace professional consultation and qualified medical care. With the slightest suspicion of the presence of tremor, you will definitely consult your doctor!
Tremor - This is a motor disorder that is manifested by involuntary rhythmic fluctuations in various parts of the body arising from the stereotypically repeated reduction and relaxation of muscles. Most often, hyperkinesis covers hands, head, feet, severe jitting limits the physical, social and professional activity of patients. The diagnosis is carried out on the basis of the data of the anamnesis, neurological inspection, the results of additional studies (laboratory tests, neurophysiological and neurovalization methods). Tremora treatment involves eliminating the cause, symptomatic correction.
Candying hypercines are a common version of involuntary movements. Although symptoms occur at any age, including children, higher rates are characteristic of persons over 65 years. Tremor is felt like a rhythmic trembling. It is often observed in the hands of the hands, reminding the bill of coins or skating pill, but may affect other parts of the body: the head (movement by the type "yes-yes" or "no-no"), torso, feet. Sometimes chin, language, voice ligaments are involved in the pathological process, which prevents eating food, disrupts the function of rebuilding.
Isolated tremor does not pose a danger to life, but violent movements make it difficult to make everyday activity. Hand shakes creates difficulties in the letter, drawing, holding cutlery and other actions requiring the participation of shallow motility (dressing, manual labor). Tremor limits professional and social activity, creates psychological discomfort, reduces the quality of life. Some types of hyperkinase are progressing over time, accompanied by neurological deficit, others disappear with the elimination of the causal factor.
Tremor or trembling is a motor impairment, which in the structure of neurological syndromes belongs to hyperkinosis. By origin, it is primary (essential) and a secondary, which is a sign of the main disease, intoxication or the action of medicines. Taking into account the etiopathogenetic features, two types of tremor distinguish:
- Physiological. He occurs in healthy individuals, is characterized by a low amplitude, not visually determined. Physiological tremor is a normal mechanism of motor control, intensified by external factors, but can consciously decrease by the patient himself.
- Pathological. Due to various disorders in the central or peripheral departments of the nervous system. The most common options are parkinsonic, cerebellar, essential tremor. There is also a dystonic, neuropathic, orthostatic and some other species.
Considering the clinical and morphological features, there is a slow (in the range from 3 to 5 Hz) and rapid trembling (6-12 Hz), low- and high amplitude (finely or large-sized), intermittent or permanent. An important criterion of systematization is the conditions of development, in accordance with the reservoir and action tremor (promotional). The latter has several varieties:
- Postural (static). Caused by maintaining the fixed position of body parts (elongated forward and divorced on the sides, head). It is considered to be the positional tremor characteristic of strictly defined poses.
- Kinetic. Located with motor acts. A simple kinetic tremor is manifested during any unfinished movements. Intentive jitter is enhanced as some purpose achieves.
- Kinesiospecific. Observed only with certain narrow-controlled actions. A characteristic example is the writer tremor, which is absent in other situations with the involvement of the same muscles.
- Isometric. It occurs under conditions of isometric muscle tension, with a strong reduction without movement. Such trembling is observed when compressed by a hand in a fist, holding a heavy item.
Topographic classification implies tremor division depending on localization. Focal affects only one anatomical zone (brush, head, soft sky, etc.), segmental covers adjacent sections (bibrachial), with a lesion of several areas on the one hand, hemiterer is stated, and involuntary movements in the whole body allow us to talk about generalized trembling. When making a diagnosis, the time of the first appearance of the symptom, family history, communication with the reception of certain substances takes place.
Why tremor arises
Causes of tremor hands
The most characteristic localization of jitter is hand brushes. Considering the physiological mechanisms for the development of tremor, the ability to strengthen with muscular fatigue, supercooling, the action of psychogenic factors (emotional shocks, anxiety). The spectrum of pathological reasons is very extensive - the main positions in it are divided into Essential Tremor and Parkinson's disease, but there are a lot of other states that can cause hand shakes:
- Endocrinopathy : thyrotoxicosis, pheochromocytoma, hypoglycemia, hyperparathyroidism.
- Metabolism disorders : Wilson-Konovalov's disease (tender, shake-rigid form), GallertsOpen-spit.
- Volumetric Education : Subdural hematoma, tumors, cavernous angioma.
- Vascular brain damage : ischemic and hemorrhagic strokes.
- Infectious diseases : neurosophilis, epidemic encephalitis.
- Hereditary pathology : Tremor and Ataxia syndrome associated with brittle X-chromosome (FXTAS), Kennedy bulbar and spinal amyotrophia, sensitive attax syndrome, neuropathy, dysarthritia and ophthalmoplegia (Sando).
- Polyneuropathy : Metabolic (diabetic, paraproteinemic, toxic), chronic inflammatory demyelinating, hereditary motor-sensory.
- Abstineent syndrome : cancellation of alcohol, drugs (cocaine, heroin), medicines (opioids, benzodiazepines).
- Inxication : Salts of heavy metals (mercury, arsenic, lead), carbon monoxide, servo carbon.
- Reception of tremorogenic drugs : tricyclic antidepressants, neuroleptics, sympathomimetics.
The development of physiological tremor is largely due to mechanical factors - the weight of the limb, the tone of muscles, the rigidity of the articular apparatus. A leading role in the formation of pathological trembling is occupied by changes in the central nervous system associated with the emergence of so-called tremor generators (central oscillators) with spontaneous or induced rhythmic activity. The second important point is the loss of control over arbitrary movements from the cerebulic system.
Causes of head tremor
Rhythmic nodies and turns head are quite common, but usually enter the picture of mixed trembling, when involuntary motor acts cover several parts of the body. Often we are talking about Parkinsonic (primary, secondary) or essential tremor. Other causes of hyperkinosis recognize the following diseases:
The Tremor of the central genesis is due to the damage to the neural ring of an extrapyramidal system, in which subcortical structures are present - basal, stem, cerebellar kernels. An important place is allocated to changes in the strollery-shade system, a rubonspinal tract, thalamic ties. The head shake occurs in the pathology of the cervical spine, which is associated with circulatory impairment, the compression of the spinal nerves.
Causes of tremor chin
The shake of the lower jaw can act as an early symptom of Parkinson's disease or neuroleptic parkinsonism (rabbit syndrome). The chin tremor is due to other reasons that require attention when conducting differential diagnostics. Increased alertness traditionally cause states characteristic of early children's age:
The physiological tremor of the newborn period arises against the background of crying, when stripping or delivering a child from water, under the influence of frightened, cold. The risk factors for the defeat of cerebral structures are infectious diseases, obstetric and somatic pathology in pregnant women. It is impossible to exclude the development of intoxication and abstinence syndrome in a child when using the mother of psychoactive means.
The diagnostic search begins with the analysis of complaints, anamnestic information and neurological inspection. Finding the trembling intensity allows the clinical assessment of tremor. If the syndromal diagnosis usually does not cause difficulties, then certain difficulties may arise with the nosological verification of pathology. For differentiation, additional methods are used:
- Laboratory tests. Some causes of tremor can be established according to the results of the biochemical analysis of blood with the determination of thyrotropic hormones, glucose, calcium, renal samples and other indicators. Toxicological tests make it possible to determine the concentration of poisoning substances, drugs, medicines. If hepatolenticular degeneration is suspected of hepatolenticular degeneration, the level of ceruloplasmin and the excretion of copper with urine.
- Tomography. Neuroviavalization is shown in a sudden appearance, rapid progression, combining tremor with other neurological disorders. MRI brain reveals atrophic, ischemic foci or other structural damage. Functionally active zones are investigated at positron emission tomography.
- Computer stability . Estimate the characteristics of postural tremor helps a stabilizer (stabilometric platform) with biological feedback. In the course of the study, support reactions are studied, including when performing diagnostic tests - static and dynamic.
- Tremorometry. The greatest distribution was obtained a method for registering involuntary rhythmic oscillations using a computer polygraph that estimates the frequency and amplitude of jitter. For the recording of the trezorogram, the strain, piezo, accelerometric methods are used.
- Electronomyography. It makes it possible to indirectly judge the parameters of trembling on the voltage and relaxing individual muscles. Electromyography helps differentiate tremor from other motor disorders, identify certain causes of trembling (polyneuropathy).
Cerebral vascular pathology detect transcranial Woods and angiography. The displacement of the median structures and the state of the ventricular system are viewed on an echoorencephalogram. Confirm the hereditary nature of certain diseases is possible molecular genetic tests. States accompanied by tremor, differentiate between themselves and with other hyperkines.
Tremor treatment is designed to reduce the functional limitations and social disadaptation of patients. The basis of therapy is conservative methods that are usually symptomatic. If the secondary tremor is stated, the treatment implies the elimination of the causes of its occurrence, the correction of the main pathology. Among therapeutic measures are used:
- Optimization of lifestyle. It is necessary to avoid situations that increase the intensity of trembling. In the early stages of the development of the disease, patients are advised to master adaptive methods - apply fountain pen and cutlery with thick handles, stupid scissors and knives, phones with voice control function, etc.
- Physical methods. The methods of physical exposure include the use of special orthheastes that limit the mobility of the brush in the wilderness of the joint. Assistance in the development of simple motor models has medicinal physical culture and ergotherapy, which are complemented by massage, reflexology and balneotherapy.
- Pharmacotherapy. For the treatment of tremor, drugs of several groups are shown. Based on clinical expediency, anticonvulsants are prescribed (Prison, Topiramat, Gabapentin), anti-Parkinsonic agents (levodopu, amantadine, pramipexol), beta blockers (propranolol, atenolol, supolyol). With pronounced Tremera head and voices, the injections of botulinumoxin A.
The ineffectiveness of conservative therapy serves as a reason to consider the variants of the surgical treatment of tremor. With severe disabled formats, implantation of electrodes in ventrolatral thalalamic or subtalamic kernels, followed by deep stimulation of the brain with high-frequency electrical pulses. Prospective methods are considered to be radio frequency ablation, ultrasound or cryotalammism under MRI control.