Parkinson’s is a disorder of the central nervous system, and affects nearly 1 million Indians every year. It is a disease that is marked with age, and can be treated but not cured. Parkinson’s patients gradually lose motor skills that hamper movement. People who face Parkinson’s disease face a lot of difficulties that tend to affect their day-to-day life. The most common symptoms that are found are shivering, shaking of limbs, fatigue, decreased motor coordination. The degradation of motor skills puts a huge toll on the person, because it alters basic skills such as walking, holding things that often, we humans take as granted. Early signs of the disease can include many uncontrollable movements, not just occasionally, but on a regular basis.

What is a Tremor?

These movements are often termed as tremors. A tremor is an involuntary movement or shake that is quivering in nature, it characteristically occurs at rest. A typical Parkinson’s disease tremor is slow and rhythmic in nature and starts in the hand, foot and/or leg, and then as it increases in nature it can be felt on both sides of one’s body. A tremor can also be felt in the jaw, chin, tongue and mouth, and additionally it can be felt internally too, which may or may not be noticeable to others.

A tremor is a common side effect of Parkinson’s, and affects 80% of the patients. It is considered by most patients to be the most annoying problem. It tends to attract too much attention. A Parkinson’s tremor is known as a resting tremor, and primarily occurs when an individual’s body is not in motion, but returns when the limb is held in one position for too long, especially when one tries to hold a spoon or fork, which is why people with Parkinson’s tend to spill more. A Parkinson’s disease tremor may affect almost any part of one’s body, and like most symptoms of the disease, the occurrence of a tremor is asymmetrical in nature. It generally starts on one side, and that side tends to remain the predominantly affected side.

Who faces Tremors?

A tremor is a side effect of Parkinson’s disease; tremor tends to occur in the hands and is often described as “pill-rolling”: imagine holding a pill between your thumb and forefinger and continuously rolling it around. About 80% of people with Parkinson’s experience a tremor at some point in the disease. Tremor appears to be slightly less common in younger people with PD, though it is still one of the most troublesome symptoms. People who are stressed and are fatigued tend to face tremors that are worse in nature, however the main types of tremors that are faced by a PD patient is as follows:

  • Finger Twitching: Fingers are a part of the body where one is most likely to notice getting tremors. A finger twitching tremor looks like one is holding a pill and rolling it in between their thumb and other fingers.
  • Jaw Tremors: A jaw tremor looks similar to one shivering, but slower. It is a common tremor that occurs in a PD patient. The Jaw tremor goes away with movement, and thus does not occur while chewing. It can sometimes be too severe and annoying, when it forces the person to click or grind their teeth together. Many patients find this tremor annoying as the teeth clicking/grinding attracts attention, thus in order to stop a jaw tremor, one is often seen chewing gum.
  • Foot Tremors: As the name suggests, it occurs in the leg and foot, especially if the limb has been kept in one position for too long, and if the heel is off the ground. A foot tremor is evident when one’s feet are dangling or if the person is lying down. It disappears when the person is standing, and hence does not while walking. While this kind of tremor predominantly occurs in the foot, it also may be felt in the thighs.
  • Tongue Tremor: A tongue tremor occurs when the head shakes, and the head shakes mainly because the arms are shaking and the tremor simply gets transmitted. Though the head shaking happens to only 5% of the population with PD.

While tremors can be felt in all parts of the body, it predominantly targets certain areas, from where it gets transmitted to the rest of the body. The main epicenters of tremors are the hands, feet, and tongue and jaw area.

Medicating Tremors:

A tremor can be a little hard to treat with medication, there are a very few medications that are used to treat tremors, as tremors is the least predictable of the four basic motor problems of Parkinson’s disease in its response to medical treatment. That’s why, when a person starts PD medication, one has to monitor tremors as well as mobility, stiffness, etc. Now most commonly, levodopa us the medication given to control tremors, along with others but there is always a risk of other physical side effects. While the hope is that the medication improves one’s tremors, it may not be very effective; at times like this
deep brain stimulation is used to successfully control tremors.

DBS or deep brain stimulation is a neurosurgical procedure involving the placement of a small pacemaker sized device called a neurotransmitter that is placed under the skin of the patient’s chest, and sends electrical impulses to the brain with the help of thin wires, in order to control movement. It is recommended for people who have PD with motor fluctuations, those whose tremors aren’t controlled by medication, or to those who are intolerant to medication. Deep Brain Stimulation is also very effective for patients with essential tremor, eliminating the need for medications and reducing tremors by 60-90%.

It is a treatment that is successful in about 90% of cases, and usually makes the tremor resolve completely or almost completely. It is not experimental and is approved by all insurance companies.

Name: Dr. Rupam Borgohain
Designation: Neurologist and academician Professor, Dept. of Neurology Nizam’s Institute of Medical Sciences (NIMS), Hyderabad

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