Involuntary, smooth, rhythmic oscillations of a body part, often leading to clumsiness or loss of dexterity, and embarrassment.
Could be fine or coarse.
A) Could be at rest with limb supported (Parkinsono’s),
B) ‘Action tremor’ with limb out stretched as in essential tremor or systemic disorder,
C) Intention tremor (cerebellar), or
D) Task-specific (e.g. writing). Cold be of head, hand, leg or voice
Causes include Familial, essential (No family history occurring in elderly), Physiologic (with fatigue/anxiety), Parkingson’s disease, elsions in cerebellum or mid brain, throtoxic, Hypoglycemic Neuropathic, Drug-induced (Beta-2 agonist, caffeine, theophylline, antidepressants, lithium, amphetamine, thyroxine, steroids, valproate), on drug- withdrawal (barbiturate, alcohol, benzdiazepines, opiates), Toxins (Mercury, MPTP), Orthostatic (shaking when standing but relieved by walking, sitting)
Asterixids is flapping of outstretched hands seen in metabolic disorders – hepatic, renal or pulmonary, due to loss of muscle tone during sustained contraction
Investigations for diagnosis would include thyroid function, serum ceruloplasmin, blood glucose, nerve conduction, electromyography, brain imaging etc.
Treatment
Action tremors helped by propranolo, 20mg tid increased ot 240mg daily gradually depending on response and tolerance. Metoprolol may betried for those with bronchospasticd disorders. Alternatives are primidone (50-500 mg/day) but adverse effects of depression, sedation and impotence limit use. Benzodiazepines may be helpful in anxiety induced tremors. Nimodepine (30 mg tid) has been found to be helpful.
Alcohol will relieve for up to 5 hours, but could be habit forming
