If you want to know what is Parkinson’s tremor and how to deal with it, keep reading this post. Here you’ll get to know about Parkinson’s tremor, its causes, and the 4 most effective ways of dealing with it.
Parkinson’s disease (PD) is a neurological condition that affects the body’s ability to perform controlled movements. The disease develops when certain cells in the brain stop producing a chemical called dopamine, which is a neurotransmitter responsible for controlled body movements.
Tremor is one of the key symptoms of PD. It primarily appears in hands or arms. Other body parts like legs, chin, face, and lips can also be affected. Some patients may show tremors in the head and voice. However, these kinds of tremors are rarely reported.
Parkinson’s tremor usually appears when the hands are at rest. This is why it’s often called a resting tremor. When it occurs, it looks like a person is trying to roll a pill between the thumb and index fingers.
In the beginning, the tremor affects one side of the body. But as the disease progresses, it spreads to the rest of the body. It becomes worse when a patient is under stress or experienced strong emotions.
It is important to know that tremor is not limited to PD. It can also appear in other neurological diseases like Essential tremor, which is more common than Parkinson’s tremor. It is said to be Parkinson’s tremor when other typical symptoms of PD, like the slowness of movement, rigidity, and problem in balance, are also present in a patient.
What Causes Parkinson’s Tremor?
Although the exact cause of Parkinson’s tremor is unknown, researchers think that the following 3 factors could contribute to the development of Parkinson’s tremor.
1. Dopamine Deficiency
Dopamine deficiency is the main reason for developing tremor and other motor problems appear in PD. It occurs when the brain lost a significant proportion of its dopamine-producing cells located deep in the middle part of the brain. By the time Parkinson’s tremor appears, the brain lost already 70% of its dopamine cells.
2. Abnormal Levels of Serotonin
Serotonin is a well-known neurotransmitter that has been linked to a variety of functions including depression, anxiety, and constriction of smooth muscles.
Research evidence suggests that an abnormal level of serotonin could also contribute to the development of Parkinson’s tremor. In fact, a recently published study has shown that Parkinson’s tremor is more likely related to serotonin than to dopamine deficiency. In this study, clinical analysis of tremor was conducted on 378 patients. It was found that the severity of Parkinson’s tremor is directly related to the loss of serotonin activity in the brainstem, part of the brain that connects the brain to the spinal cord.
Similar findings were also observed in other related studies.
3. Alteration in the Specific Parts of the Brain
In addition to chemical changes, structural changes in the brain could also cause motor abnormalities in PD. Researchers have found that alteration in specific parts inside the brain could lead to the development of motor symptoms of PD. These parts include the substantia nigra, thalamus, and basal ganglia.
Substantia nigra is located in the mid-region of the brain, and it contains a large number of dopamine-producing cells. It is involved in the control of various body movements. Thalamus is a small part of the grey matter of the brain that receives and passes on sensory information. Basal ganglia are a group of small structures that are attached to the thalamus. These structures are involved in body movement and other functions.
How to Deal with Parkinson’s Tremor?
Tremor is the most disturbing symptom of PD. It can be frustrating and embarrassing. It gets worse over time and makes it difficult for a person to perform simple hand tasks like eating, drinking, writing, and dressing. If not treated properly, it can exacerbate the patient’s condition.
Here are the four ways of dealing with Parkinson’s tremor.
1. Medication
Medication is the most effective way of dealing with Parkinson’s tremor. The most commonly prescribed drugs are those that belong to a class of drugs called anticholinergic. These include benztropine, orphenadrine, and trihexyphenidyl. These were the early drugs used to treat PD. They are named anticholinergics because they act by blocking the action of acetylcholine, which is a neurotransmitter involved in muscle movement. This action of anticholinergics results in the activity of brain cells responsible for movement.
Anticholinergic drugs come with side effects including constipation, dry mouth, urinary retention, and dementia-like symptoms.
A drug called levodopa could also be effective against the tremor. This drug is used as first-line therapy for PD. Although it is primarily used for the slowness of movement and rigidity, it can relieve the tremor of a patient to some extent. But the problem with levodopa is that it loses its efficacy over time and instead of improving, it further exacerbates the tremor. Moreover, it comes with several other side effects like nausea, insomnia, low blood pressure, and some psychological effects.
Other drugs like clonazepam, amantadine, and clozapine are used when the patient’s tremor is no longer controlled by anticholinergics and other first-line drugs used for PD.
2. Surgical Approach
If the tremor is very severe and all the prescribed drugs are failed to control it, a surgical approach called deep brain stimulation is used. Although this approach was first developed for essential tremor, it is now more commonly used for treating Parkinson’s tremor.
It involves a surgery during which electrodes are installed inside a patient’s brain. The chip is targeted to brain regions involved in the controlled movement of the body. The electrodes produce a current that helps to get rid of the abnormal brain activity that caused the tremor. The current is adjusted with the help of a stimulator (a pacemaker-like device) that is placed in the upper chest area.
The surgery is expensive and not everyone can afford it. Also, it comes with complications including infection, bleeding in the brain, and potential risk of hemorrhage. But despite these side effects, it is still considered very effective and becomes a routine treatment for patients suffering from an advanced stage of Parkinson’s tremor.
3. Physical Therapy
Physical therapy can also be effective for people with Parkinson’s tremor. It mostly involves performing hand exercises that improve hand strength and flexibility. For example:
- Holding a ball in hand and squeezing it for few seconds
- Flick the hand up and down
- Spinning a pencil in between the fingers
- Supination and pronation of both hands
- Finger thumb tapping
Resistance training that includes dumbbell bicep curls, wrist flexion, and wrist extension exercises twice a week could also help to relieve the tremor to some extent.
Please check our blog about the “7 most effective hand exercises for hand tremor” for more detail.
4. Behavioral Changes
Adopting certain behavioral changes may also help to reduce Parkinson’s tremor. These changes include:
- Avoid drinking alcoholic and caffeinated drinks
- Staying away from stress
- Stop using antidepressant drugs
Additionally, people with Parkinson’s tremor are also encouraged to use assistive devices for their daily tasks. Many different types of assistive devices are available on the market and while using them will not treat the tremor, they certainly help to reduce the tremor’s effects during drinking, eating, and writing.
Here are a few examples of such devices: