Parkinsonian Tremor

Parkinsonian Tremor – General Information

Parkinsonian Tremor can be caused generally by problems in brain or spinal cord structures which control motor muscles in the body such as hand muscles. The nervous system disorders that can produce tremor are traumatic brain injury, multiple sclerosis, stroke and neurodegenerative diseases which can damage or obliterate brainstem or cerebellum parts. Other tremor causes may be the use of drugs like caffeine, amphetamines, corticosteroids or psychiatric disorder drugs, the abuse of alcohol or withdrawal from it, poisoning with mercury, an overactive thyroid or a failure of the liver. Tremors might indicate from hypoglycemia and palpitations to sweating and anxiety. Tremor can be inherited, or just appear suddenly with no known cause. Tremor can occur disregarding age, but it is more common for middle-aged and old people. Tremor may occur intermittently or it may be occasional and temporary.
Parkinsonian Tremor can be caused by damage to the brain structures which control movement. The settlement of Parkinsonian Tremor is usually at people with ages of over 60 years old. This particular tremor is worse than other types of tremors at rest position and may cause insomnia. These tremors can be drug-induced also, by dopamine receptor blockers like haloperidol and some antipsychotic drugs. The Parkinsonian Tremor is tremor could be triggered by or become really exaggerated due to stress or strong emotions, when the man is physically exhausted, or in certain postures or movements.

Parkinsonian Tremor – Symptoms

The main symptom of the Parkinsonian Tremor is the non-intended, somewhat rhythmic, movement of the muscles which involve to-and-fro movements which are also called oscillations, of one or more body parts. It is the most common movement of all involuntary ones and may affect the hands, vocal cords, head, arms, face, trunk and legs. Most tremors appear in the hands. The most common tremor form occurs at healthy people. Tremor is not life-threatening, but it’s embarrassing for some people and makes the performance of daily task harder.
 
Parkinsonian Tremor symptoms include:

1. Rhythmic shaking in the hands, trunk, head, arms and legs
2. Shaky voice
3. A difficulty in writing or drawing
4. Problems in controlling and holding utensils
5. A “pill-rolling” action of the hands which may be present in the legs, lips, chin and trunk. Movement may start in a limb or body side and after a while it usually makes progress into the other side.
6. In some cases: weakness, muscle atrophy, reflexes which are decreased.
7. Postural instability
8. Difficulty walking
9. Bradykinesia (slowness in voluntary moving and speaking)
10. Bad coordination
11. Bad muscle control and strength
12. Bad motion control
13. Problems in doing everyday actions like eating

All these symptoms appear as a result in the lack of dopamine production by the brain. The tremor is progressive and there is no certain way of how to stop it permanently yet.

Parkinsonian Tremor – Treatment

For most tremors there is no actual cure yet. The appropriate treatment can be selected only after the cause of the tremor has been accurately diagnosed. Some tremors may respond to treatment of conditions that are underlying. Parkinsonian tremor may be treated using drugs like levodopa or dopamine-like drugs such as pergolide mesylate, bromocriptine mesylate or ropinirole. Other drugs that are used to lessen Parkinsonian tremor are amantadine hydrochloride or anticholinergic drugs.

          This is the most efficient anti-Parkinsonian tremor drug available, which was invented in 1967 and treats symptoms like bradykinesia, stiffness, tremor and walking difficulty. When this drug is taken alone, the body breaks is down to about 95 percent to dopamine before it reaches the brain and this fragment is taken to the blood flow, provoking actions like nausea or vomiting before it is metabolized. Observing these side effects, doctors have combined this drug with another one called carbidopa and have created Atamet/Sinemet which is a drug that has the power to take more dopamine to the brain, being more effective against stiffness and bradykinesia, but is less effective against shaking and balance problems. As time passes, the effect of this drug is weakened and patients need larger and larger doses of this product for it to be efficient.

2. Anticholinergics

            When brain dopamine levels drop, there is another neurotransmitter which is called acetylcholine becomes overactive. This imbalance between dopamine hypo activity and acetylcholine hyperactivity leads to the problems in the motor system. Anticholinergics block the overpowered actions of the acetylcholine. Drugs like trihexiphenydil (Artane), biperidine (Akineton) are to be used in the primary stages of the Parkinson Tremor and can diminish tremor and drooling, but are ineffective against posture instability or bradykinesia.
 
3. Lifestyle treatment

It is efficient and recommended to eliminate caffeine or other stimulants from your diet. Physical therapy can be used in some cases to improve muscle control and coordination. Some doctors teach patients to brace the affected limb while it is affected by tremor. Therapists may recommend using splints, weights or other adaptive equipment and special utensils and plates for eating.

4. Surgery

Surgical interventions like thalamotomy or deep brain stimulation can ease certain tremors. Surgeries like these can be usually performed when the tremor is not responding to drugs.

1. Thalamotomy – involves the creation of lesions in the thalamus (a brain region), and is really effective in treating patients with Parkinsonian tremor. The procedure is performed only in hospitals under local anesthesia, with the patient awake. The lesion makes the tremor disappear permanently without affecting motor or sensory control.
2. Deep brain stimulation – this is another way to treat Parkinsonian tremor. It uses electrodes which are to be implanted with the use of sending high-frequency electrical impulses to the thalamus. The patient can use a hand-held magnet to activate or deactivate a signal generator which is implanted under skin surgically. The tremor is disabled temporarily by the electrical stimulation and can be “reversed”, by deactivating the electrode. Batteries can be replaced surgically and last for 5 years.

Common side-effects of the tremor surgery can include dysarthria (speech problems), permanent or just temporary cognitive impairment (difficulty in understanding and learning) and balance problems.