What is the tremor disease, how are the symptoms ?

Tremor is unintentional and uncontrollable rhythmic movements seen in one or more parts of the body. It is most common in the hands, but it is a common movement disorder in the arms, head, vocal cords, trunk and legs. Shivering may occur anywhere and any time. This is usually the result of a problem in the part of the brain that controls muscle movement. It may occur sporadically (on its own) or as a result of another disease. It should be noted that muscle spasm, muscle twitching and tremor are not the same. Muscle spasm is the involuntary contraction of the muscle. Muscle twitching is an uncontrolled twitching movement of a small part of a larger muscle. This twitch can be seen under the skin.
Although it can be seen at any age, tremor is more common among middle-aged and older adults. The disease usually affects men and women equally. Shivering is not always serious, but in some cases it may indicate a serious illness. Tremor is not life threatening, but it can make it difficult or even impossible to perform work and daily life tasks.
What are the causes of tremor?
Tremor is usually caused by a problem in the deep part of the brain that controls movements. Most types of tremor do not have a known cause, but there are some forms of inheritance. Tremor may occur on its own or may be a symptom associated with various neurological disorders, including:
• Multiple Sclerosis (MS)

* Stroke
* Traumatic brain injury
* Neurodegenerative diseases affecting parts of the brain (eg, Parkinson's disease).
Other known causes include:
* Use of certain drugs (specific asthma medications, amphetamines, caffeine, corticosteroids, and medications used for certain psychiatric and neurological disorders)
* Dependence on alcohol dependence or release phase
* Mercury poisoning
* Overactive thyroid
* Liver or kidney failure
* Anxiety or panic
What Are Tremor Symptoms?
Tremor manifests itself in some symptoms. These symptoms may be one of the following.
* Rhythmic tremors in hands, arms, head, legs or trunk
* Shaky sound
* Difficulty in writing and drawing problems
* Keeping spoons, utensils, and control problems in
some times it can also be triggered or worse.
How is Tremor classified?
Tremor can basically be divided into two main categories:
Resting tremor occurs when the hands are resting on the lap and the muscles relax. With this disorder, a person's hands, arms or legs can be shaken and trembling, even at rest. Shivering usually affects only hand or fingers. Such tremors are usually seen in people with Parkinson's disease, and patients are called hast pill-roling tremor “because they make circular fingers and hand movements similar to those of small objects or pills.
Action tremor occurs by the voluntary movement of the muscle. Most tremor types are considered to be action tremor. Action tremor has several subcategories, many of which overlap.
Postural tremor occurs when a person has a position like gravity, for example, by extending his arms and holding something.
Kinetic tremor is associated with any voluntary movement such as moving wrists up and down or closing and opening eyes .
The purposeful tremor comes with a targeted, purposeful movement, such as lifting a finger to touch the nose. As they approach their goals, the individual's tremors typically increase.
Task-specific tremor is seen only when performing highly skilled, targeted tasks, such as handwriting or speech.
Isometric tremor occurs during a voluntary muscle contraction that does not accompany any movement, such as a heavy book or a dumbbell being held in the same position.
Different Tremor Types
Tremor is often classified by its appearance, cause, or origin. There are more than 20 types of tremor. Some of the most common types of tremor are:
Essential tremor (previously called benign essential tremor or familial tremor) is one of the most common movement disorders. The exact cause of essential tremor is unknown. For some people, this flicker is light and stable for years. Shivering is usually seen on both sides of the body, but the dominant hand is more noticeable because it is action shake.
The essential feature of essential tremor is that it is on both hands and arms, during movement and while standing. Additional symptoms are trembling as the head moves ar yes i or “no Ek. The sound vibrates when the vibration affects the larynx or throat. In essential tremor, both shaking can cause problems during writing, drawing, drinking water from a cup, or using a device such as a computer.
The tremor frequency (swinging speed) may decrease as the person ages, but the severity of the person that affects the ability to perform certain tasks or activities in daily life may increase. Increased excitement, stress, fever, physical fatigue, or low blood sugar can trigger and / or increase the severity of tremor. Although tremor starts at any age, it may occur for the first time in adolescence or in middle age (between 40 and 50 years of age). Taking small amounts of alcohol can help reduce essential tremor, but the mechanism behind it is unknown.
Approximately 50 percent of cases of essential tremor are thought to be caused by genetic risk factors. Children who have a parent with familial tremor have a higher risk of developing the disease. Familial forms of essential tremor are usually seen in the early stages of life.
Essential tremor has not been associated with any disease for many years. However, some scientists believe that essential tremor is associated with a slight degeneration of certain regions of the brain that control movement. This thought is an ongoing debate in the field of research in the scientific world.
Dystonic tremor occurs in people affected by dystonia. Dystonic tremor is usually seen in young or middle-aged adults and may affect any muscle in the body. Symptoms can sometimes relax with complete relaxation. Although some of the symptoms are similar, dystonic tremor is different from the essential tremor in some respects.
Dystonic tremor:
* Strong muscle spasms or cramps due to abnormal body posture
* Essential tremor may affect the same parts of the body, but at the same time no other movement in the head, hands or arms.
* Can mimic rest tremor as seen in Parkinson's patients.
* The severity of the dystonic tremor can be affected by touching the affected body part or muscle. and tremor movements are ”jerky ve or irregular rather than rhythmic.
Cerebellar tremor is a slow, high amplitude (easily visible) tremor of the extremities (eg, the arm, leg) that typically arises at the end of a purposeful movement, such as pressing a button. Cerebral damage is caused by damage to pathways leading to stroke or other brain areas originating from the tumor. Damage may also be caused by hereditary degenerative diseases such as multiple sclerosis or ataxia (where individuals lose control of the muscles in the arms and legs) and Fragile X syndrome (a distinct disorder with various intellectual and developmental problems). It may also be caused by chronic injury of the cerebellum due to alcoholism.
Psychogenic tremor (also known as functional or functional tremor) may appear as any form of tremor. Symptoms may change, but they often start suddenly and affect all body parts. Shivering increases in times of stress and diminishes or disappears when attention is distributed. Many individuals with psychogenic tremor have an underlying psychiatric disorder, such as depression or post-traumatic stress disorder.
Physiological tremor is seen in all healthy individuals. It is rarely seen in the eye and is typically in the form of a fine shake of both hands and fingers. It is not a disease, it is a normal phenomenon that results from physical features in the body (rhythmic activities such as heartbeat and muscle activation).
Increased physiological tremor is a more evident physiological tremor that can be easily seen. It is not usually caused by a neurological disease, but by some drugs, a lack of alcohol, or a reaction to medical conditions, including an overactive thyroid and hypoglycemia. Generally recyclable after correcting the cause
Parkinson's tremor is a general symptom of Parkinson's disease, but not all patients with Parkinson's disease have tremor. Generally, symptoms include flickering at one or two hands at rest. It can also affect the chin, lips, face and legs. The tremor may initially only be seen in one limb or only on one side of the body. As the disease progresses, it can spread to both sides of the body. Tremor often worsens in the presence of stress or excessive excitement. More than 25 percent of people with Parkinson's have action-related tremor.
Orthostatic tremor is a rare disease characterized by rapid muscle contractions in the legs while standing. People often have a feeling of being unstable or unbalanced. When patients want to stand up and walk, they should appear and sit. Since the tremor is at a very high frequency, it may not be visible to the naked eye, but it can be felt by touching the thighs or calves or by a doctor who examines the muscles with a stethoscope. In some cases, tremor may become more severe over time. The cause of orthostatic tremor is unknown.
How is Tremor Diagnosed?
Tremor is diagnosed by physical and neurological examination based on the medical history of the individual. A doctor makes the assessment according to:
* Tremor occurs when the muscles are standing or moving?
* The place of vibration in the body (it occurs on one side or on both sides of the body?)
* The appearance of the vibration (flicker frequency and amplitude).
The doctor will also check for other neurological findings such as imbalance, speech disorders or increased muscle stiffness. Blood or urine tests may rule out metabolic causes such as certain medications that may cause thyroid dysfunction and tremor. These tests can also help identify causes that contribute to drug interactions, such as chronic alcoholism or other conditions or diseases. Diagnostic imaging can help determine whether tremor is the result of damage to the brain.
Additional tests may be applied to determine functional limitations such as difficulty with handwriting or a fork, cup holder. Individuals may be asked to perform a series of tasks or exercises, such as touching a finger at the tip of a nose or drawing a spiral.
The doctor may request an electromyogram (EMG) to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.
How Tremor Is Treated?
Although there is no treatment for most forms of tremor, treatment options are available to help manage symptoms. In some cases, symptoms may be too mild to require treatment.
Deciding on appropriate treatment depends on the correct diagnosis of the cause. Shivering due to underlying health problems can sometimes be completely eliminated by treatment. For example, tremor associated with thyroid hyperactivity is improved (even to normal) by treatment of thyroid dysfunction. In addition, shaking can reduce or eliminate flicker if the shake occurs due to medication.
If there is no underlying cause of tremor, the available treatment options may be:
Beta-blockers : Beta-blockers such as propranolol are normally used to treat high blood pressure, but are also helpful in the treatment of essential tremor. Propranolol can also be used for other types of action tremor in some individuals. Other beta-blockers that may be used are atenolol, metoprolol, nadolol and sotalol.
Antiepileptics : Some antiepileptic drugs such as Mysoline containing Primidone may be effective in basic (essential) tremor patients who do not respond to beta-blockers. Other prescribable drugs include gabapentin and topiramate. However, it is known that certain anti-seizure drugs may cause tremors.
Trankilizan drugs:Tranchilans such as Alprazolam and clonazepam, also known as benzodiazepines, may temporarily assist the tremor. However, their use is limited due to undesirable side effects including drowsiness, poor concentration and poor coordination. These side effects can affect people's ability to perform daily activities such as driving, going to school, or going to work. Also, when taken on a regular basis, tranquilizers can cause physical dependence and may cause various withdrawal symptoms when left suddenly.
Parkinson's disease drugs : Levodopa, carbidopa drugs such as Parkinson's disease is used in the treatment of tremor.
Botulinum toxin injectionsAlmost all types of tremor can be treated in this way. It is especially useful for head shaking that does not respond to medication. Botulinum toxin is widely used to control dystonic tremor. Although botulinum toxin injections can improve tremor for about three months at a time, it can cause muscle weakness. This treatment is effective and is usually well tolerated for head shaking and may cause weakness in fingers when used for hands. When treating the vibration of the sound, the sound may cause thickening and difficulty swallowing.
Focused Ultrasound
Magnetic resonance images accompanied by focused ultrasound is a new form of treatment for essential tremor in the thalamus region of the brain, creating a lesion in small areas thought to be responsible for tremors. Treatment has been approved for essential tremor patients who do not respond well to anticonvulsant drugs or beta-blockers.
Surgical Intervention
If patients do not respond to drug therapies or have severe tremors that affect their daily lives significantly, doctors may recommend deep brain stimulation (DBS) or very rarely surgical interventions such as thalamotomy. While DBS is generally well tolerated, the most common adverse side effect of surgery is dysarthria and balance problem.
Deep brain stimulation (DBS):The most commonly used form of surgical treatment of tremor. This method is preferred because it is effective, carries a low risk and treats a wider range of symptoms than the thalamotomy. It uses surgically placed electrodes to deliver electrical signals with a high frequency to the thalamus region, which coordinates and controls some involuntary movements of the brain. A small stimulating device (similar to a pacemaker) placed under the chest beneath the skin sends electrical stimuli to the brain and temporarily blocks tremor. DBS is currently used for the treatment of essential tremor, Parkinson's tremor and dystonia.
thalamotomyIt is a surgical procedure that involves the precise and permanent destruction of a tiny area in the thalamus. Today, when deep brain surgery is contraindicated, surgery is replaced by radiofrequency ablation to treat severe tremor. Radiofrequency ablation uses a radio wave to heat a nerve and produce an electric current that typically disrupts signaling capability for six or more months. It is usually done on only one side of the brain to improve flicker. Operations on both sides are not recommended, as it may cause problems with speech.
Lifestyle Changes
Physical, speech and occupational therapies: It can help control tremor and deal with daily challenges caused by tremor. A physiotherapist can help to improve muscle control, functioning and strength of patients through coordination, balance, and other exercises. Some therapists may recommend the use of items such as weights, splints, other adaptive equipment, special containers for food and dishes. Speech and language pathologists can evaluate and treat speech, language, communication and swallowing disorders. Occupational therapists can teach individuals new methods of performing daily life activities.
Eliminate or reduce flickering substances such as caffeine and other drugs:It can help greatly improve tremor. Although small amounts of alcohol may reduce tremors in some patients, the effects of alcohol may worsen tremors when taken too much.
How is the course of the disease?
Tremor is not considered a life threatening situation. Although many cases of tremor are mild, they may be too obstructive for some people. It may be difficult for individuals with tremors to perform normal daily activities such as working, bathing, dressing and eating. Shivering can also cause ğ social insufficiency Tit. People can limit their physical activity, travel and social responsibility to avoid shame or other consequences.
The symptoms of essential tremor often worsen with age. In addition, there is some evidence that other neurodegenerative conditions, such as Parkinson's disease or Alzheimer's disease, are less likely to develop in people with essential tremor, especially those who first appear after age 65 of tremor. Unlike essential tremor, the symptoms of physiological and drug-induced tremor often do not worsen over time, and the underlying causes can often be cured or eliminated when treated.
What Researches Are Done?
The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to explore basic information about the brain and nervous system and to use this information to reduce the burden of neurological diseases. NINDS is a component of the National Institutes of Health (NIH), a leading supporter of biomedical research in the world. Researchers are working to better understand the brain functions that cause tremors, identify genetic factors that make individuals more susceptible to the disease, and develop new and better treatment options.
Brain Functions
It may be difficult to differentiate movement disorders such as Parkinson's disease and essential tremor. These debilitating movement disorders have different prognoses and can give very different responses to existing treatments. NINDS researchers work to identify structural and functional changes in the brain using non-invasive neuroimaging techniques to develop sensitive and specific markers for each of these diseases, and then monitor how the disease progresses as it progresses.
Other researchers use functional magnetic resonance imaging technology to better understand normal and diseased brain circuit functions and related motor behavior. Scientists hope to design treatments that can restore normal brain circuit function in diseases such as Parkinson's disease and tremor.
Research has shown that essential tremor may have a strong genetic component that affects many generations of the family. NINDS researchers add new ones to previous genetic studies to identify susceptibility genes for familial early onset (prior to age 40) essential tremor, and focus on multi-generational, early-onset families to better identify the links. NINDS scientists also investigate the effect of genetic abnormalities on the development of essential tremor. Previous studies show that there is a link between essential tremor and possible genetic variants with chromosomes 6 and 11, and ongoing research is aimed at the effect of other genetic variations in families.
Drugs and Other Treatment Methods
Although drugs are effective on some individuals, about 50 percent of patients do not respond to the drug. In order to develop anti-flicker devices for assistive and rehabilitation purposes for essential tremor patients, researchers are looking for voluntary movements to explore where and how to minimize or suppress tremors.
Many people with essential tremor respond to alcohol (alcohol), but it is not clear why or how. NINDS investigators investigate the effect of ethanol on shake and whether other drugs without side effects will be effective on ethanol to determine the correct dosage and physiological effect in the brain.
Other NIH researchers hope to identify the source of essential tremor, to investigate the effects of existing tremor suppressants in the brain, and to develop more targeted, effective therapies.

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