Tremor

Question 1

causes of tremor?

Answer 1

BET
Physiological tremor.
Exaggerated physiological tremor due to illness, fever, hyperthyroidism, anxiety states, etc.
Post-traumatic/post-neurosurgical tremor.
Medication/drug-induced.
Multiple sclerosis.
Parkinsonism and Parkinson’s-plus syndromes - eg, multiple system atrophy, progressive supranuclear palsy
Metabolic derangement - eg, electrolyte disturbance, renal and hepatic failure.
Wilson’s disease.
Cerebellar disease.
Basal ganglia lesions.
Dystonias.
Other movement disorders - eg, tardive dyskinesia, cerebrovascular disease.
Writer’s cramp or tremor.
Psychogenic tremor.
Arsenic, heavy metal, organophosphate or industrial solvent poisoning.
Vitamin deficiency (especially B1).

Question 2

classification of tremors

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Answer 2

REST tremor
Rest tremors occur when the body part is supported against gravity - eg, hands at rest in one’s lap. Mental stress or general movement makes rest tremors worse.

ACTION tremors
—–are further subdivided into static, postural or kinetic tremors:

–Static - occurs in a relaxed limb when fully supported at rest. Causes include Parkinson’s disease, Parkinsonism, other extrapyramidal diseases and multiple sclerosis.

–Postural - occurs when a part of the body is held in a fixed position against gravity (it can also remain during movement). Types include physiological tremor, exaggerated physiological tremor (eg, thyrotoxicosis), anxiety states, alcohol abuse, drugs (see below), heavy metal poisoning, neurological diseases, Wilson’s disease, neurosyphilis, peripheral neuropathies, essential (familial) tremor and task-specific tremors such as primary writing tremor.

—Kinetic or action tremor - occurs during voluntary active movement of an upper body part. If action tremor worsens as goal-directed movement approaches its intended target, this is intention tremor (indicative of a cerebellar cause). Associated with brainstem or cerebellar disease, including multiple sclerosis, spinocerebellar degenerations, vascular disease and tumours.

Question 3

symptoms of essential tremor?

Answer 3

Symptoms
Essential tremor (ET):
This is usually a distal symmetrical postural tremor of the upper limbs, usually of low amplitude with a fairly rapid frequency of 8-10 Hz.
It may initially be transient but usually progresses to become persistent.
The neck muscles may be involved, causing tremor of the head (about 40% of cases). Voice, face and jaw muscles may be involved.[3]
Frequency of the tremor tends to remain constant but amplitude is highly variable depending on emotional and physiological state.
Background tremor amplitude tends to progress over the course of years.
Some degree of control over the tremor, exerted by concentration on a task or via execution of a skilled manual repertoire, is common.
Tremor does not occur during sleep.
Most report improvement of tremor following alcohol ingestion.
It may be difficult to distinguish from exaggerated physiological tremor, that caused by hyperthyroidism/fever or tremor due to medications; these causes should always be borne in mind before diagnosing ET.

Question 4

classification of tremor?

Answer 4

Tremor
———-Resting tremor Present at rest but abolished on voluntary movement. Most common cause—PD when tremor is rhythmic

———-Intention tremor Irregular large amplitude tremor worse on movement, e.g. reaching for something. Typical of cerebellar disease

————Tremors on movement Thyrotoxicosis, anxiety, benign essential tremor (inherited), and drugs (e.g. β-agonists) cause a fine tremor abolished at rest. Alcohol and β-blockers may help

Question 5

drugs that may cause a tremor?

Answer 5

Beta agonists, thyroxine