INTRODUCTION:
They are typical signs of extra pyramidal or cerebellar disorders and can also result from the use of certain drugs.
Tremors can be characterized by their location, amplitude, and frequency.
CLASSIFICATION:
Resting: Resting tremors occur when an extremity is at rest and subside with movement. They include the classic pill-rolling tremor of Parkinson's disease
Intention : intention tremors occur only with movement and subside with rest.
Postural : Postural also known as action tremors appear when an extremity or the trunk is actively held in a particular posture or position. A common type of postural tremor is called an essential tremor.
MEDICAL CAUSES
• Alcohol withdrawal syndrome: Acute alcohol withdrawal after long-term dependence may first be manifested by resting and intention tremors that appear as soon as 7 hours after the last drink and progressively worsen.
• Alkalosis: Severe alkalosis may produce a severe intention tremor along with twitching, carpopedal spasms, agitation, diaphoresis, and hyperventilation.
• Benign familial essential tremor: This disorder of early adulthood produces a bilateral essential tremor that typically begins in the fingers and hands and may spread to the head, jaw, lips, and tongue. Laryngeal involvement may result in a quavering voice.
• Cerebellar tumor: An intention tremor is a cardinal sign of this disorder.
• General paresis: This effect of neurosyphilis may cause an intention tremor accompanied by clonus.
• Graves' disease: Fine tremors of the hand, nervousness, weight loss, fatigue, palpitations, dyspnea, and increased heat intolerance are typical signs and symptoms of this disorder.
• Hypercapnia: Elevated partial pressure of carbon dioxide may result in a rapid, fine intention tremor.
• Hypoglycemia:Acute hypoglycemia may produce a rapid, fine intention tremor accompanied by confusion, weakness, tachycardia, diaphoresis, and cold, clammy skin.
• Kwashiorkor: Coarse intention and resting tremors may occur in the advanced stages of this disease.
• Multiple sclerosis: An intention tremor that waxes and wanes may be an early sign, but visual and sensory impairments are usually the earliest findings.
• Parkinson's disease: Tremors, a classic early sign of this degenerative disease, usually begin in the fingers and may eventually affect the foot, eyelids, jaw, lips, and tongue. Flexion-extension of the fingers combined with abduction-adduction of the thumb is known as the characteristic pill-rolling tremor. The rate of the tremor remains constant over time, but its amplitude varies.
• Thyrotoxicosis: Neuromuscular effects of this disorder include a rapid, fine intention tremor of the hands and tongue, along with clonus, hyper reflexia, and Babinski's reflex.
• Wernicke's encephalopathy: An intention tremor is an early sign of this thiamine deficiency.
• Wilson's disease: This disorder of abnormal copper metabolism produces slow developing tremors in the arms and pill-rolling tremors in the hands; these tremors appear early in the disease and progressively worsen. The most characteristic sign, however, is Kayser-Fleischer rings rusty brown rings around the corneas.
OTHER CAUSES
• Drugs: Phenothiazines and other antipsychotics may cause resting and pill-rolling tremors.
• Porphyria: Involvement of the basal ganglia in porphyria can produce a resting tremor with rigidity accompanied by chorea and athetosis. As the disease progresses, generalized seizures may appear along with aphasia and hemiplegia.
• Thalamic syndrome: Central midbrain syndromes are heralded by contralateral ataxic tremors and other abnormal movements along with Weber's syndrome oculomotor palsy with contra lateral hemiplegia, paralysis of vertical gaze, and stupor or coma.
• West Nile encephalitis: This brain infection is caused by West Nile virus, a mosquito-borne flavi virus endemic .Mild infections are common and include fever, headache, and body aches, commonly accompanied by rash and swollen lymph glands. More severe infections are marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional seizures, and paralysis. Death rarely occurs.
THERAPEUTICS:
AGARICUS:
Trembling of both the extremities
Sensation of pins and needles at the peripheral regions
The affected parts are cold to touch
Formification of affected parts
PLUMBUM MET:
Paralysis with atrophy is the watch word of this remedy
Paralysis of the extensors
Tremor is followed by paralysis
Ptosis, heavy tongue, constipation, paralysis after apoplexy with pale dry cold skin are the other characteristic features of this remedy
Upper extremities are much more effected than lower extremities
MERC SOL:
This is one of the principal remedy for the paralysis agitans.
It is best suited for pin rolling tremors which are found in the parkinsons disease.
The patient is unable to catch hold of the glass and it slips down from his hands.
Tremors resulted due to mercurial poisoning and abuse of drugs.