Tremors are unintentional trembling or shaking movements in one or more parts of your body. Most tremors occur in the hands. You can also have arm, head, face, vocal cord, trunk and leg tremors. Tremors are most common in middle-aged and older people, but anyone can have them. Some forms are inherited and run in families. Others have no known cause.
There is no cure for most tremors. Treatment to relieve them depends on their cause. In many cases, medicines and sometimes surgical procedures can reduce or stop tremors and improve muscle control. Tremors are not life-threatening. However, they can be embarrassing and make it hard to perform daily tasks.
Tremors occur when there is a problem in parts of the brain that control muscles in the body or specific parts of the body, such as the hands. They commonly occur in otherwise healthy people. They may also be caused by problems such as:
- Parkinson’s disease
- Dystonia
- Multiple sclerosis
- Stroke
- Traumatic brain injury
- Alcohol abuse and withdrawal
- Certain medicines
Why choose Ohio State for treatment of tremor?
Multidisciplinary Team of Experts: We have a team of experts dedicated to treating tremor disorders at both the Madden Center for Parkinson’s Disease and Related Disorders and at the Center for Neuromodulation. They include:
- Movement disorders neurologists with fellowship training or extensive clinical experience in movement disorders
- Social worker
- Physical, occupational and speech therapists
- Nurse practitioners and a clinic nurse
- Neuropsychiatrist who can address related behavioral and mental health issues
- Genetic counselor
- Coordinated efforts with a specialized team of neurologists, neurosurgeons and nurse practitioners experienced in assessing and treating those individuals with tremor disorders who might benefit from deep brain stimulation (DBS)
Comprehensive Care: Our experienced team provides you with multiple options in three different clinic locations for managing tremors. We also work closely with other disciplines to address conditions in which tremors occur, such as Parkinson’s disease, multiple sclerosis, stroke and dystonia. Once we have diagnosed your condition and underlying causes, we provide ongoing follow-up care and make adjustments to your treatment along the way so you can achieve the highest possible level of function.
Physical Therapy Expertise: Our physical therapists specialize in movement disorders and are known for their research and work in setting the standard of physical therapy care for movement disorders, particularly in gait (manner of walking) and balance assessment and treatment.
Diagnosing Tremor
There is no blood or laboratory test to diagnose tremors. Sometimes imaging studies, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may be used to rule out other disorders with tremors.
A DaTscan can be useful in diagnosing essential tremor (rhythmic shaking in almost any part of your body). The scan is an imaging test that uses small amounts of a radioactive drug to help determine how much dopamine (a brain chemical involved in movement) is available in your brain. We use a single photon emission computed tomography (SPECT) scanner to measure the amount and location of the drug in your brain. A shortage of dopamine points to Parkinson’s disease rather than other causes of tremor.
Tremors can run in families, and we have a genetic counselor who can answer your questions about genes and movement disorders.
Treating Tremor
There is no cure for tremor. Current treatment strategies aim to decrease the tremor, so that you can have a better quality of life. We can also refer you on to other specialists for related disorders such as Parkinson’s disease, multiple sclerosis, stroke and dystonia.
Our Movement Disorders Clinic can prescribe medications for symptom relief. Options include:
- Anti-convulsives: Mysoline (primidone)
- Beta-blockers: Inderal (propranolol)
- Anti-anxiety medications: buspirone and clonazepam or alprazolam
- Other medications, including gabapentin and topiramate
One of Ohio State’s strengths is our physical therapy program, which includes therapists who specialize in movement disorders. Our focus is on helping people maintain their highest level of function and movement. It may be possible to “overpower the tremor” by adding extra weight to an ankle or wrist or using a weighted utensil.
We also can help you manage motor, cognitive and psychiatric impairments that affect your ability to move.
We will assess you through a variety of tests and recommend the best therapies for your needs. These may include:
- Training you to walk with regular steps to improve your balance and prevents falls
- Working with you to safely transfer on and off of chairs and toilets to help you to be more independent
- Assessing you to recommend appropriate walking or assistive devices
- Teaching you exercises to improve strength, flexibility, coordination and balance, and maintain fitness and health
Our occupational therapists, who specialize in movement disorders, assist you in performing work and leisure activities, as well as activities of daily living. We can assist you with adaptations to household items. For example, adding weights to items such as pens, eating utensils, brushes, canes or walkers can increase muscle control. Arm and hand braces may also work well for tasks like eating or writing.
Our movement disorders speech therapists can help you with difficulties swallowing and with slurred or stuttering speech. In severe cases, when tremor affects clarity of speech, you may be referred to an ENT (ear, nose and throat) specialist who can selectively administer botulinum toxin using electromyography-guided injections.
If you do not find relief from symptoms with conservative treatments, we may refer you to our Center for Neuromodulation for deep brain stimulation (DBS). DBS involves surgically implanting tiny electrodes into the brain and connecting them to a small pacemaker-like device (programmable battery) that has been implanted into the chest wall. The electrodes deliver tiny electrical signals that calm abnormal brain signals. The goal of these electrical signals is to alleviate disabling tremors.
Research
Our participation in national and international clinical trials for movement disorders provides you with access to the latest options in medications and treatments, often long before they come to market.
Additional Information
You will be mailed an appointment reminder along with new patient forms that ask you about symptoms, medications and medical history. We ask that you also be prepared to answer questions about your family history. We ask that you have the doctor referring you send us your medical records. Please also bring your own copies of records or CDs of imaging studies, as well as a list or bottles of medications and dosages you take or have taken for tremors.