Q My mother’s hands are shaking more than usual. Can you tell me if shaking is always a sign of something serious, like Parkinson’s disease?
A This kind of shaking is called a tremor. Tremors can affect hands, limbs, head or voice. A person can’t control a tremor. most of us can get temporary tremors as a normal reaction to fear, anger or when we are tired.
Too much caffeine or nicotine (in heavy smokers) can cause a tremor. so can withdrawal from an addictive substance (powerful painkillers or alcohol).
Many commonly prescribed drugs also can cause one. Examples include drugs used to treat depression such as selective serotonin reuptake inhibitors (SSRIs), tricyclics and lithium; the asthma drugs terbutaline and theophylline; and potent anti-inflammatory drugs such as prednisone. Lowering the dose of the medicines may reduce the tremor.
One common disease, hyperthyroidism (overactive thyroid) can cause tremor. two other common kinds of tremor are essential tremor and Parkinsonism.
It is usually easy to tell the difference. Essential tremor is most noticeable when a person is in action. it can come on when someone is doing everyday things like writing a note or pouring tea.
It’s the opposite with Parkinson’s disease tremors. Those occur at rest, as when a person is sitting still with hands in the lap. When he or she reaches out to grab something, the shaking stops.
There are other symptoms that help to tell the difference. with Parkinson’s, it’s more common for the tremors to start on one side of the body.
Also, it is more common for tremors to involve the legs and to make walking difficult. Finally, people with Parkinson’s lose facial expression.
One thing that has helped me diagnose essential tremor in the past may sound odd, but an alcoholic drink can stop the tremor for an hour or so. If this works, it may be essential tremor.
I am not recommending a drink per hour as treatment of essential tremor! Instead, there are two medications that can help control essential tremor: propranolol and primidone, which produce chemical reactions similar to those caused by alcohol.
Only your mother’s doctor can correctly diagnose the cause of her tremors. Fortunately, most tremors are not caused by Parkinson’s and can be successfully treated.
Write to Anthony Komaroff via his website, AskDoctorK.com, or co Universal Uclick, 1130 Walnut St., Kansas City, MO 64106.