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Neurology (Expert Forum)
'internal Tremor'
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'internal Tremor'
by Mark Parsons, Mar 15, 2000 12:00AM
I had sudden onset of symptoms 3 months ago that were at first
headache, neck pain and "internal Tremor" After about 1 month
the headache subsided and I was left with a severe "internal Tremor"...that is my head feels like it is shaking but is not.
Slowly this has progressed to a feeling in my arms going down
to my hands. All blood work neg. MRI...normal. Have developed
what they think is PN. Also was diagnosed with "fine tremors'
in both eyes. The neurologist have conflicting opinions.
Essential tremor? I have a certain response to alcohol but none
to Inderal. Finally, because the sensation was so strong and troubling, I was put on Ativan which really reduces the tremor.
1 mg twice a day. When I go off the Ativan the tremor returns
I am so frustrated.
Why can I not find much about "internal tremors"? Could this
be orthostatic tremor" Why is the eye sight involved?
Thank you for your time
headache, neck pain and "internal Tremor" After about 1 month
the headache subsided and I was left with a severe "internal Tremor"...that is my head feels like it is shaking but is not.
Slowly this has progressed to a feeling in my arms going down
to my hands. All blood work neg. MRI...normal. Have developed
what they think is PN. Also was diagnosed with "fine tremors'
in both eyes. The neurologist have conflicting opinions.
Essential tremor? I have a certain response to alcohol but none
to Inderal. Finally, because the sensation was so strong and troubling, I was put on Ativan which really reduces the tremor.
1 mg twice a day. When I go off the Ativan the tremor returns
I am so frustrated.
Why can I not find much about "internal tremors"? Could this
be orthostatic tremor" Why is the eye sight involved?
Thank you for your time
Doctor's Answer
by CCF Neuro[P] MD, RPS, Mar 15, 2000 12:00AM
Dear Mark Parsons:
Sorry to hear about your problems. I am not sure what you mean by "internal tremors". Is this a condition where you feel your muscles twitching? Or is this where you feel you insides tremor? Is it only your head and upper extremities that has this internal tremor? When you say your eyes have fine tremors, is this visable to your neurologists? Do you have eye tremors only when your looking at objects, looking straight ahead, tracking objects? Since the neurologist think this is peripheral neuropathy, have they done an EMG?
The good news is that your MRI and the blood work was normal. An EMG would help alot. An essential tremor can include the head and extremities (look at Katherine Hepburn). Some essential tremors do not respond to beta blockers, some will repond to premidone. An essential tremor has a characteristic frequency of 7-13 hertz and will seen on EMG. There are so many things that can cause tremor. Did the neurologist say that you had a jaw tremor or a tremor when you yawned? If so, a trial of a dopamine agonist might help matters.
I am sorry that I am not helping you much. The differential on tremor is so large.
CCF Neuro MD
Sorry to hear about your problems. I am not sure what you mean by "internal tremors". Is this a condition where you feel your muscles twitching? Or is this where you feel you insides tremor? Is it only your head and upper extremities that has this internal tremor? When you say your eyes have fine tremors, is this visable to your neurologists? Do you have eye tremors only when your looking at objects, looking straight ahead, tracking objects? Since the neurologist think this is peripheral neuropathy, have they done an EMG?
The good news is that your MRI and the blood work was normal. An EMG would help alot. An essential tremor can include the head and extremities (look at Katherine Hepburn). Some essential tremors do not respond to beta blockers, some will repond to premidone. An essential tremor has a characteristic frequency of 7-13 hertz and will seen on EMG. There are so many things that can cause tremor. Did the neurologist say that you had a jaw tremor or a tremor when you yawned? If so, a trial of a dopamine agonist might help matters.
I am sorry that I am not helping you much. The differential on tremor is so large.
CCF Neuro MD
only way I can get the tremors to subside
opportunity to Post that I was very incomplete. Yes, The feeling
is a pulsing "internal tremor" not a muscle twitching. It is only in my head and arms...I feel like I am shaking like Kate
Hepburn but I don't look like I am shaking! The neuro's don't
see the tremor...only the eye doctor when she dialated both eyes.
They are "fine tremors" Said you see them in Parkinsons. The
tremors manifest as a feeling of floating, feet not on the ground. There is no loss of actual vision. LYING DOWN AFTER
A PERIOD OF TIME CALMS THE TREMORS! Is that significant diagnostically? Plus the ativan has helped. Alcohol also will
stop the feeling of "internal tremor" for a short period!
Any further ideas. No, I have not had an EMG. Can Tremor
be related to perifieral and not central nervous system?
Thanks...your site is the best...I want to help with funding!!!
I would not say that you have Parkinson's. You have none of the symptoms associated with Parkinson's. Yes, tremor can be seen in peripheral neuropathies. However, one should see other changes with a peripheral neuropathies. Without examining you I can't tell what you have. An EMG would help define a physicial etiology for your tremors.
CCF Neuro MD
In your reply to Mark you mentioned yawning. Just curious, what is the diagnostic significance of tremor/shaking when you yawn. Is this the same as tremor when you stetch?
Many thanks!
Dennis
You mentioned alcohol calms your tremors. How much do you drink? Do you drink everyday. Alcohol withdrawal can cause tremors! I used to drink around the clock to stop my tremors from the alcohol withdrawal. Once off the alcohol and past the withdrawal, the tremors are gone. Ativan is one of the drugs used to help alleviate some of the symtpoms of alcohol withdrawal, mainly the shaking and potential DT's and seizures.
During the time I started drinking round the clock to stop the shakes, I did not even know it was withdrawal. I thought alcoholism was only psychological. I did not know it was a physical addiction.
at all! I was asked to try alcohol by the Neurologist to see
if the tremor responded to it and it does (im talking about
a half glass of vine!
When we can see a tremor in the chin region during a yawn, depending on the other parts of the neurological exam, we might be more worried that a patient may, may have the early signs of Parkinson Disease. This is a very soft call and only a well experienced neurologist would be able to give a diagnosis based on only this.
CCF Neuro MD
I, too, have pulsing tremors but in my sacral region and down near my left thigh. Nothing helps. I've tried Valium (similar to Ativan) and it did not help. my doctor thought I could have had an inflammation as I used to have pain but the pain is gone and the tremor is still there. I have completely normal lab tests and like you have no idea what to do next. Mine feels something like a combination of my pulse and tremors. I think the sensory nerves are involved because I can sometimes feel "sparks" down my legs. It is definitely not the sciatic nerve for me. Did you ever have an injury to your head, etc. that could have caused a "trigger point?" If I massage the area, it gets irritated. Lying down helps a little but what helps the most is vigorous exercise! Sometimes I think not enough blood is getting to the little sensory nerves and when that happens, they shake. Do you put pressure on that side of your head when you sleep? If you do, try to stop and see what happens. I've been dealing with this for two years now and it has gotten to be a little more localized. Moist heat also helps me sometimes but never ice! Let us know what is happening with you. I know from experience how awful it is and it would be 1000x worse to have it in the head region than down by my thigh! If I find any answers at all, I will let you know. Good luck. Oh, PLEASE never combine alcohol