'internal Tremor'

[Mark Parsons]

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

[CCF Neuro[P] MD, RPS]

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

[Mark]

Forgot to mention...that lying down and being very still is the
only way I can get the tremors to subside

[Mark]

Thank you for responding. i was so shocked to actually have the
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!!!

[CCF Neuro[P] MD, RPS]

Dear Mark:

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

[Follow-up Q for RPS re. tremor]

Dear RPS,

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

[Barbara]

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.

[Mark]

Thanks for your message Barbara....no I don't actually drink
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!

[CCF Neuro[P] MD, RPS]

Dear Dennis:

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

[Dianne]

I have recently been diagnosed with Essential Tremor but my doctor declined to give me a prognosis as to whether or not the tremors would get worse. Some of the research I have done indicates that it is a progressive disease.  Are there any statistics relating to this?  I was adopted, so there is no family history available. It would be helpful to me for planning my future as I own and operate my own business which relies on my being able to function normally.  Any information would be helpful.  Thanks.

[To Mark From Gabrielle]

Hi Mark,

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 and Ativan!  I hope the doctor told you this.  I have never tried alcohol for mine so don't know if it would help or not.

[Audrey]

Mark, I know what you mean about the internal tremor.  I always describe it as the devil's in me feeling. I also have a tremor that gets so bad my legs won't support me at times.  It comes and goes with varying severity and is only relieved by lying perfectly still.  Is essential tremor present all the time or can it come and go?  I had a subarachnoid hemmorage followed by neurosurgery to remove an AVM in the right parietal lobe.  My neurologist suggested brain damage although I have no disabilities except some weakness on my left side.  He also suggested hypersensitivity to normal amounts of adrenaline. Do these sound like possibilities?

[CCF Neuro[P] MD, RPS]

thanks for your concern.

CCF Neuro MD

[Kimberly Rae]

I have tremors in my neck. I started getting them when I was 21. I am now 33. Up until a year ago, they were not bad enough to see a doctor about. My mother also has tremors in her neck. It basically looks like we are shaking our heads "no". Hers started in 1976 and have gotten progressively worse. She has mostly always taken Ativan to control this problem. I have taken Ativan for about 4 months. Now, a new neurologist wants me to try different medications to see which work better. I am now taking a beta blocker which doesn't seem to be working as well. I should also mention that I am a nervous person and the Ativan also seems to work better for this problem. When I am relaxed and am at home, I don't need to take the medication as my neck doesn't tremor as much. As I work retail, the tremors become embarrasing at work. While other family members don't have this as an ongoing problem, they too show symptoms when they are faced with stressful situations. My concern is that I know Ativan is highly adictive. My mother has gone through withdrawal once and it was pretty scary. My other concern is that I have heard that taking Ativan causes tremors in elderly people. I also have to mention that in 1995, I was involved in a car accident and fractured C1 & C2 in three places. I had a halo on for 3 months and everything is fine now. My neuro-surgeon said that in many cases, people have had to have fusion surgery after about 5 years. The muscles can no longer support the head. I have reached 5 years and seem to be okay, but what affect will my tremors have on my neck? I am scared that if I can't find a way to stop them that my neck will become worse and I will have to have the fusion, meaning I will have no movement in my neck anymore. Does anyone have any suggestions?

[CCF Neuro[P] MD, RPS]

Dear Kimberly Rae:

I am not sure what you are trying to ask.  Ativan can be a good medication for tremors or essential tremor as you have.  The beta blocker would have less side effects than ativan, you should tell your physican that the dose you are on is not working that well. Primadone also works well on essential tremor.  I would cross the fusion surgery if and when it happens.  There is little you can do about this anyway, currently except to try and maintain correct posture, reduce axial load (such as neck lifts, bad technique with lifting etc).

Sincerely,

CCF Neuro MD

[Laura]

I have been reading your responses and questions, and wonder if anyone out there has found an answer. I also have these, ever so aggravating, tremors, and nothing has shown up in my blood work-not low blood sugar, not an over active throid...nothing. I am 22 years old and this has been going on for about 3 months. If anyone can tell me ANYTHING, it would be greatly appreciated!

[Gabrielle To All Who Are Suffering From]

Two years ago I began suffering from tremors in the sacral area.  My doctor thought they were psychosomatic because they would ease up whenever I would go out of the house, e.g. go shopping, to a restaurant, on a trip, etc.  All of my tests were normal.  I took a LOT of abuse from a physical therapist because no physical cause could be found--the doctor was sympathetic, but couldn't help much.  I began to think, "What do I do differently when I go out that I don't do at home?"  The answer was clear.  I took a Sinequan (doxepin) which is a tricyclic antidepressant.  (It has a tranquilizing effect.)  Then I thought back to the time the tremors began.  "What was different in my life then?"  I stopped Sinequan suddenly.  I was on the lowest possible dose, 10 mg. per day with 20 mg. of Inderal (beta blocker) and stopping should not have been a problem, but I have ALWAYS been hypersensitive to ANY medication and medications give me side effects that are unheard of in other people.  (For example, both omeprazole and Voltaren interferred with my periods.)  I went back on the Sinequan and Inderal and the tremors immediately started to quiet down.  Now, only four days into the therapy, they have almost stopped.  Most of you will NOT be as sensitive to medication as I am and this may not be the problem for all of you or the solution.  My point is--don't let ANYONE tell you it's psychosomatic if you, yourself, know it isn't!  Keep looking until you find the answer no matter how hard it is and how long it takes!  Rule out EVERYTHING physical and I mean EVERYTHING!  Do what I did.  Think of the times when it is quiet and see if you can find a common denominator.  Try to find out if something changed when the tremors started.  I know stopping the Sinequan suddenly is what caused two years of hell and misery for me.  I went to this Forum's search engine and typed in "nerve damage" and I found that one neurologist said tricylic antidepressants slow the nerve impulses and are often used to control tremor.  My hyperexcitable nervous system just couldn't adjust.  I found the answer only through persistent digging.  Your answer is out there, too.  I hope all of you find it.  I will be thinking of all you every day and hoping you eventually find your answer just as I found mine.  GOOD LUCK!!!!!

[Pam]

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