NERVOUS SYSTEM – Tremor – Hands more in trouble
Tremor means shaking or trembling or being unstable. Medically it is termed as paralysis agitans. Even though tremor is a simple and a non-life threatening disorder, it can make one’s mind collapse like the tremor of the earth. The sufferers who just will not be able to hold a cup of coffee to drink or who cannot sign will have that sort of mind. Nature will be appreciated for its coordinated movements when one loses them.
Tremors are shaky involuntary movements (occurring on their own) occurring just like tic, twitch, epilepsy, chorea, dyskinesia, myoclonus, etc. You cannot find a technique to stop it. It can occur in anyone at any time. It may be persistent or occasional, regular or irregular and usually has oscillatory character. It can occur in any part of the body or in the whole body, i.e., head, neck, hands, legs, trunk, tongue, etc. But its effects are more pronounced in the fingers/hands, since they are not always supported like other parts and also used for very fine movements. It may be accompanied by rigidity (tightness of the muscle) or flacidity of muscle.
Commonly, one will tremor when facing a new, tensed situation, unfamiliar circumstance or event, etc, i.e., while going for exam, attending an interview, meeting high officials, hiding the truth, signing important documents, etc. Having tremor at that time makes one feel embarrassed for fear of failure in task execution/skilled performance, even though they know and can do everything. In due course, they will be avoiding those occasions, making themselves functionally disabled or handicapped to that specific task. Most often, youngsters feel tremor as a part and parcel of sexual weakness which has been rewarded to them for their over sexual indulgences. Of course, tremor can alarm. But it need not to be related to that. Tremor occurring in cold temperature, i.e., shivering, is a compensative mechanism of the body to produce heat to combat cold.
Assessment –One would have tremor for very fine movement – like threading a needle, aiming for
a win in games like golf, billiards, carom board, shooting gun, etc. These should be considered as normal just like our oscillating mind. Medically, tremor will be associated with various activities and movements (with and without support), i.e., writing, lifting, touching tip of the nose by index finger of extended hand with closed eyes, standing erect with closed eyes, etc.
Incidences and causes – In olden days, tremor was more commonly seen in elderly people, but nowadays, worries, anxiety, tension, overtime job, sleeplessness pushes even youth to suffer from tremors. Additionally, the habit of stimulants, i.e., coffee, alcohol, smoking, drugs, adds fuel. Also using chemical medicines has this sort of tremor as side-effect. All incidences are seen more in people over the age of 50, irrespective of sex. It can occur due to unstable joints / movements and weakened muscles. Even though tremor can occur in the head, legs, body, vocal cord, etc., its incidences are more in the hands.
Regarding ultimate cause – most often it is found to be multi-dimensional with facets of age,
stress, tension, anxiety, sleeplessness, sugar level, genes, injury, stroke, paralysis, other diseases, etc. In broad spectrum it can be classified as
- Physiological tremors – that occur in everyone at any time, i.e., due to age, anxiety, fear, fatigue, tension and shouting with anger, lowered sugar levels, dehydration, alcoholism, withdrawal symptoms of alcohol, smoking, drugs, etc. They will go off once the situation or circumstance gets adjusted or with withdrawal of stimulants or drugs.
- Pathological tremors – occurs due to diseases like diabetes, neurological disorders, thyroid dysfunction, etc.
- Psychological tremors – are often induced to attract others for betraying their weakness – It will not be there during their sleep and while they are distracted.
- Essential tremors – are the most common tremors where one cannot find a cause. It may or may not progress to cause difficulty in day-to-day activities. It is more common in adults and often
misdiagnosed in children.
Pathology – Tremor is supposed to be the oscillation between the coordination of mind and body. Stability and movement is usually carried out by our cerebellum i.e., hind brain. Our body positions are kept informed to the brain by vestibular apparatus in the ear. Scientific evidences have now proved and identified certain specific parts of brain which cause these tremors. They are thalamic nucleus, globus pallidus and basal ganglia. They are collectively called as central (neural) oscillators. Disorders in basal ganglia generate ‘Parkinsonism’. Dysfunction of cerebellum, thalamic nucleus and globus pallidus make other tremors.
Symptoms – usually vary depending upon the nature of disease and age of the sufferer. Commonly:
- Shaking or vibration or oscillating fingers/hands causing difficulty in performing day-to-day activities like writing, eating, drinking, shaving, dressing, etc.
- Needs support to stop tremors
- Stammering speech depending upon the disease caused and parts affected
- Fatigue and weakness
- Depression and sleeplessness
Types – There are many types of tremors. Its nature, intensity and possibility of cure vary according to the disease or cause. The different types of tremor are
- Action / intention tremor – occurs while starting / when intending to start / while doing functions / movements. It may be for fine or coarse movements or for specific task
- Resting tremor – most commonly it will be a symptom of Parkinsonism. Even though it can affect all parts of the body, most often it is noted in hands as pill rolling tremor.
- Cerebellar tremor – occurs due to alcohol intake, stroke, sclerosis, can be drug induced, etc. It can cause stammering and instability with lack of coordinated movements.
- Postural or orthostatic tremor – occurs due to instability or weak joint / muscles
- Familial tremor – are inherited. Here genes play a major role
- Dystonic tremor – occurs due to impairment in muscle tone. It will usually have betterment by support and rest.
- Senile tremor – occurs in aged persons
Diagnosis and investigation – Commonly, the patient himself comes with diagnosis or with suspicion of cause for actual complaint (when it is related to his habits or anxiety or tension). But the patient needs to be analysed with CT or MRI scan and EEG (if necessary) to rule out involvement of the brain. Also the patient should go for routine blood tests, urine tests and hormonal assay to analyse anaemia, thyroid dysfunctions, metal poisoning, etc. With detailed case taking or history, laboratory investigations and physical or neurological examinations, the patient can be diagnosed for the specific condition and treatment plan can be aimed at.
Complications – Feeling disabled or handicapped to do specific tasks in spite of having all the body parts makes one depressed. Also in severe cases, difficulty in coping with day-to-day activities makes the sufferer think if it is worth living.
Prevention and management – One needs to monitor stress, sleep, diet, medication and stimulants for preventing as well as managing tremor.
- Open minded and share your feelings or fears
- Busy with work or job to forget all sort of illnesses
- Active and do physical exercises regularly
- Regular with medications
- Racing against time
- Circumstances which favour anxiety
- Overloading brain / mind anticipating trouble
- Addictives – drinking alcohol / coffee, smoking and drugs
- Being more cautious about it since it makes the complaint progress
- Unnecessary medicines
- Stopping stimulants all of a sudden – better to taper it
General treatment – If tremor occurs only during fine movements, people usually manage by themselves without going for any treatment but if it disturbs day-to-day activities, one will get depressed soon and go for treatment at the earliest. One should be aware that it will be always worth attending a dysfunction in the start-up itself.
Commonly, neurotransmitters blockers or anti-seizure medicines or beta blockers, mild tranquilisers or calcium channel blockers with supplements are prescribed to treat tremors according to the causes. Actually, with treatment, many drugs can help but nothing seems to cure it ultimately. Also side-effects of the drugs can frustrate.
In rare cases, as a last resort, surgery (deep brain stimulation or thalamotomy) will be advised. Even though there are a good number of success stories in these cases, occasional failure or side-effects like loss of speech, paralysis, fatality, etc., make the sufferer think about it in extreme condition only.
Suppressing a tremor can be done by any means, i.e., simple support can suppress the tremor, alcohol can suppress tremor, anti-seizure drugs can suppress tremor, sedative medicines can suppress tremor. But, their dependency, inconvenience, side-effects and increasing dosage in due course makes one seek alternative treatment to get rid of tremors. Stress reduction is crucial to have good effect, but constant suffering makes the sufferer more annoyed and would often increase it. In spite of it all, stress reduction certainly helps in getting out of tremors without side-effects.
With any system of medicine, early treatment is the best; if it is opted very late or in advanced condition, then any system will only be able to reduce it to a limit. Homeopathy is in no way
an exception to this. One would be compelled to accept this. But sometimes, with proper Homeopathy treatment, it can be minimised even to near normal without any side-effects. Selection of Homeopathic medicines usually depends upon the cause of the disease, nature of the illness, its progress and symptoms presentation. Also, the patient needs to be educated about the complaint, need for lifestyle changes (if any) and management, to meet life’s challenges easily without any dejection. Homeopathy can surely ease their condition further by supporting nerves, muscles, brain and coordinating their function for comfortable living.
Homeopathic medicines commonly used in cases of tremors are Agaricus, Ambra grisea, Apis mel, Aur met, Arg nit, Ars alb, Avena sativa, Belladonna, Calc phos, Cannabis indica, Causticum, Damiana, Ferrum phos, Gelsemium, Heloderma, Hyosyamus, Hypericum, Kali phos, Lachesis, Lathyrus, Lycopodium, Natrum mur, Nux vom, Physostigma, Plumbum met, Pulsatilla, Rhus tox, Selenium, Silicea, Stramonium, Strychinum, Tarentula, Valeriana, Zinc met, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.
Dr. S. Chidambaranathan, BHMS, MD
24 E. New Mahalipatti Road
Tel: +91-452-233-8833 | +91-984-319-1011
(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)