tremors

[Philip]

I am having tremors in both of my arms and legs. From time to time it is more severe in my right hand. But my tremors are intense in my left and right leg as well as my left arm. These tremors happen when I extend my arms or lift my foot from the floor. My doctor did an MRI and ruled out Parkins, Wilson disease.He also stated it that I did not have a brain tumor. He has me on Mysoline and I take 4 250 mlg a day. The medicine has not done anything as of yet I have been on this medicine for about 2 months. I was wondering if this could be Essential Tremors. The nurse at the Dr.'s office said no but I do not understand why I am having these tremors. Pleas pass along any info you can. This is a very embarassing problem.
Thanks Phil
P.S. I am 30 if that helps any.

[CCF Neuro[P] MD, RPS]

Dear Philip:

Sorry to hear that you have tremors.  The type of tremor that you speak about, tremor with muscle movement or in action, is called a action tremor.  Essential tremor is tremor at rest or when your muscles are relaxed.  Parkinson's tremor is usually a resting tremor that goes away with movement.  The differential is wide including unknown (sorry), medication, stroke (unlikely in your case), dystonia (also unlikely), degenerative disease of the basal ganglia or cerebellum, anxiety, toxins, etc.  However, if a general practioner diagnosed your tremor, it might actually not be a tremor but faciculations.  Difficult to tell you without a visual exam.  Give the medication a few more days, if no effect let your neurologist know.

Sincerely,

CCF Neuro MD

[Paul]

What is Lhermitte's sign? Is it present all the time or does it come and go? How do you check for it (standing? sitting?). When I bend my neck forward-sometimes I feel a twinge in my arch-not both only one and never standing. Only occassionally not all the time. Could this be it?

[CCF Neuro[P] MD, RPS]

Dear Paul:

Lhermitt's sign is when you flex your neck and feel twinges or radiation of pain down your back and maybe into your thighs.  It is not radiated to your arches.

CCF Neuro MD

[Mark]

My name is Mark and I'd like to ask a doctor about tremor.  I've been having these slight shakes mainly in my fingers which I notice mainly when I'm eating (using a fork and knife) or when I'm drinking when the glass approaches my mouth.  What bothers me most is that I feel so embarrased that my heart beat increases and the tremor increases.  I can't say that the shakes are large but at times there worse than usual.  I'm so embarrased about the situation that I hardly go out to eat with my girlfriend anymore and lately started to drink some alcohol to relieve the shakes. When i do go out to eat i'm constantly looking at other people to see if there looking at me. I'm not a drinker or smoker but I've been taking antihistamines for about 5 years (Claritine- Loratidine).  I've tried to quit them but its no use because a rash develops within a day.  My doctor told me that I'm atopic.  The rash is like hives and I know there caused by certain foods but its too hard to tell so I gave up. A patch test is no use my doctor told me. I went to another doctor for the tremor and she took some blood tests and found that my thyroxine levels were just near the upper limit. she didn't give me any medication except for propranolol for the tremor.  The propranolol helps a little but i'm not happy with having to take it and i don't.

I definetely need some help.

Thanks

[CCF Neuro[P] MD, RPS]

Dear Mark:

Sounds like you have essential tremor.  Interestingly, up to 50% of essential tremor is inherited.  We do not understand it's etiology.  There are other medications besides the beta adrenergics.  You might want to try primidone (used at much lower doses than for seizure control), carbonic anhydrase inhibitors, and some recent studies suggest that dopamine agonists might work.  One thing that should be ruled out is Wilson's disease.  This might be the first manifestation of this disease.  A simple serum ceruloplasm and urine copper test will rule this out.  

Sincerely,

CCF Neuro MD

[Sharon]

I have another question about tremors, when my hand is at rest or  hanging down it is ok.  When i hold up my hand while the arm is resting on an armrest, my hand and fingers shake.  It is mainly in my right hand, but has started recently in the left.  I first found it a couple of months ago, was just sitting there with a cigarette in my index and middle fingers.  My right hand has also gotten weaker.  I know I shouldn't smoke and am going to try to quit.  Do you know what could be causing this?

Thank you

[CCF Neuro[P] MD, RPS]

Dear Sharon:

There are many reasons that could cause this, from essential tremor, vitamin deficiency, Parkinson's, Wilson's, drug withdrawal, medications, etc.  Over the internet, it is impossible to give you an idea without examining you and taking a good neurological history.

Sincerely,

CCF Neuro MD

[Sharon]

Thanks for your quick answer doctor, I rally appreciate it.  Sorry, I asked an unappropriate question, I meant to say, what kind of tremor do you think it is.

Thank you so much.

[CCF Neuro[P] MD, RPS]

Dear Sharon:

It might be an essential tremor.

CCF Neuro MD

[GARRY]

My father has been diagnosed as having Benign Essential Tremors, i have been told that there is no cure for this. He is getting in a bad way with it, is there anything that i can tell him to try. I have also been told that there is a very good chance that i will get this aswell. Is there any help groups i can contact, thank you Garry.

[Gail Vergara]

My husband has developed a tremor in his jaw and lip.  It is not constant and if I call his attention he can stop it.  What are the possibilities?

[Moya]

dear doctors
the love of my life has been diagnosed with essential tremor a few years ago. he had the d.b.s. surgery which was a failure. he is on mysoline and inderol which does nothing . he can't feed himself. please, what about xanax or remerol or something new. his life was music and successfully until this. i need help to help him.
please respond

[CCF Neuro[P] MD, RPS]

Dear Moya:

I am not sure what to tell you.  I would seek another opinion for a movement specialist.  Usually deep brain stimulation is the last resort when medications failes.  If this too has failed, then the options are likely very limited.  I wish I could tell you something different.  However, I would still see another movement specialist to see if there are medication options.

Sincerely,

CCF Neuro MD

[Benn on Sat 5/2/2000]

I have an essential tremor, I'm 24 and I believe I was born with it , I've had the shakes since I could remember. Over the past 5,6 years the embarresment of it has given me a social phobia, Like alot of people with a benign or essential tremor alchohol and beer in particular calms and sometimes stops it. I want to know why I have been warned from drinking alcohol at all when I see it as the only way I can deal with some social events. I know that people can become alcoholic but if I only drink 2 times a week surely this is not a danger. It has not increased over the last 5,6 years either so why would I abstain from one of the only things that I see as a saving grace, one of the only things that allows me to enjoy social situations.
Any help would be appreciated.

[CCF Neuro[P] MD, RPS]

Dear Benn:

I am not sure what sort of social comment you want me to make.  I am sorry that you have an essential tremor.  Many thousands of people also have essential tremors.  There are other medications that can control your condition so alcohol is not an excuse for treatment.  If you want to drink that is up to you, but don't make your condition a crutch for drinking.  If you want to drink that is your choice. This is the wrong forum for social issues.

Sincerely,

CCF Neuro MD

[benn]

Sorry you misunderstood, my specific question is, what are the problems that can arise from drinking when you have an essential tremor, and can it make a tremor worse in the long run.thankyou.

[CCF Neuro[P] MD, RPS]

Dear Benn:

Alcohol will help mask the tremor.  It will not affect the tremor in any other way.

CCF Neuro MD

[Eva]

I have been geeting tremors now for the past year but getting worse, when I get upset or anxious.  Even at rest I can be at church and my hands or legs start shaking.  I am also getting flutters and dizzy spells, feeling like my head is in an elevator.  My memory is now starting to get the best of me and is now interfeering with my work and social life.  My doctor's tell me I am too young to have any heart problems or nerve problems. Can you give me any advise??

[CCF Neuro[P] MD, RPS]

Dear Eva:

I have patients who are 3 years old with nerve problems.  Since I cannot examine you, see your tremor, I cannot be very much help.  As you can see, tremors can happen in any age group and can be caused by a variety of problems.  I would see a neurologist.

Sincerely,

CCF Neuro MD

[FRAN]

a friend 60 yrs old, who has been on medication for bi polar disorder for about 20 years has developed a tremor .   His physicians advised him that he had Parkinson's .  Last week he said now his doctor isn't sure whether it is Parkinson's or the result of so many years on lithium ,depakote and other medications for bi polar.

Can you advise him as to which clinical tests may serve to make the distinction between the two ?  I don't know which have been run.

i thought last year i read there is a test where you draw concentric circles and a computer analysis of the drawing can make such a distinction.  if this is accurate do you know of a facility nearby in the Phila metro area that does this or other definitive tests? thanks

[CCF Neuro[P] MD, RPS]

Dear Fran:

Too high of a dose of lithium can give you tremors.  These may or may not be different from the tremors of Parkinson's.  If the tremors are bilateral, e.g. each arm and hand, then it is more likely to be due to lithium.  If the tremor is at rest and when the limb is used and the tremor goes away, it is more likely to be due to Parkinson's.  But, the only real way of telling is to get a lithium level and see a good neurologist.

CCF Neuro MD

[Fred]

I've a strong history of family essential tremor.  Have had slight postural right hand tremor for 3 years, worsening in last year and more noticeable when I try to type too fast.  As a nervous habit over the last year, also began tapping my right foot when anxious.  This now seems to have developed into a tremor when holding down the gas pedal when driving.

MRI is normal, reflexes normal, balance normal, 50 years old with normal blood work up and very active.  Neurologist says ET sometimes goes on to PD and thinks I may be developing early signs of Parkinson's because of slight rigidity detected in right arm (I've also had impingement of right rotator cuff and associated pain which physical therapy has improved.)  Neurologist says we'll just have to wait and see for sure.  

What do you think?

[CCF Neuro[P] MD, RPS]

Dear Fred:

Sorry to hear about your tremor.  A Parkinson's tremor is one of a resting, pill rolling tremor.  An essential tremor is one of tremor with posture or action.  They are different, especially during the early stages of the disease where the Parkinson's tremor is distinctly resting.  However, there are always exceptions to every rule. It sounds like you have essential tremor and not the Parkinson's resting tremor.

Sincerely,

CCF Neuro MD

[alicia]

You said that meds can sometimes cause tremors.  Which ones?  Long story, but I am currently taking several.  I asked the doctor and he said that none of them could cause this Side effect. I believe him on an individual basis, but I am taking one muscle relaxer for AM skelaxin, one PM soma, thyroid, quiniline, hydrocodone, imitrex,and Ibuprofen.  I also take a stjohns wart complex in place of an antidepressant.  I know that in the presence of so many meds a reaction is possible.  Now my doctor wants to add another one for the tremors.  I have always had normal bp and am concerned on more than one level about another med.  He said I have benign et, but this is new for me.

Do you think it could be the meds?

[rose]

I'm sure I suffer from essential tremors, my whole family shakes and I've had the shakes since I was 13.  It can be a major social problem, but I try to remind myself that only I KNOW I have it, and people arent just looking at me to see if I'm shaking or not. Writing in front of people is hard, I shake too bad, and also holding a cup or glass can be embarressing, especially if you clink your teeth!!! If they ask, I simply tell them I have essential tremors!  I usually try to laugh it off, but have to confess at times it gets the better of me.
Up until two years ago I took propranolol 40 mg 1 per day, it worked well, but I had my thryoid removed (I had Graves disease) and since then have not been able to take this or any other beta blocker, they make me feel real lousy, lower my blood pressure, and affect my TSH levels.  I have resorted to taking diazepam, which is helpful, but I do not like the addictive qualities of this drug.  
Does anyone have any suggestions for me in regards to medication expecially anything that will not affect my TSH levels etc but would assist me on my 'bad tremor days'.
In the meanwhile, its good to try and keep smiling!

[CCF Neuro[P] MD, RPS]

Dear Rose:

Some patient get relief with primidone, an anti-seizure medication.

CCF Neuro MD

[Rita]

Hi I have a son that will be two soon, I was just wondering if I can get an answer to this problem.  He has had tremors in the legs and arms on and off since he was born the Dr say it is normal for babies to have them when he reached a year old they seem to be a lot less but I have to say when he is tired or just wakes up in the morning I have noticed a slight tremor on his legs (both of them) I have not seen them in the arms anymore, it looks like the way he positions his feet that causes the tremor, a physical therapist examined him and called it clonus, but it sounds pretty serious,  Any suggestions on this matter please write back.

***@****
Thank you
Rita

[Aileen]

My head tremors did not being until right after my father's
death 7 yrs ago and he developed them in his early 70's.I am
most aware of them when I am either standing still or
sitting.  They are not constant but come and go throughout
the day, some days worse than others.  Does cutting back
on caffein have any effect on them?  I have eliminate
asparteme from my diet thinking that could have influence
but so far not.  Are there things that make them worse?

[CCF Neuro[P] MD, RPS]

Dear Arileen:

Caffeine may be causing your tremors to be increased.  Try stopping all caffeine and see if things get better.

CCF Neuro MD

[CCF Neuro[P] MD, RPS]

Dear Rita:

Having some mild jerking either going into or coming out of sleep is usually a normal finding in an infant, or even a older child.  Some adults also have this behavior, and it is considered normal.  However, if the jerking happens while your infant is awake then I think you ought to have him checked out by a pediatric neurologist.

Sincerely,

CCF Neuro MD

[JM]

What will a brain scan tell?  My husband is scheduled for

one because of gait problems, and minor tremors of feet.

He has fallen three times, says he can't really tell

where his feet are, consequently stumbled.  Also says

he has an odd feeling in the top of his head.  

[Pam]

A year ago I had a pain in the left side of my head.  Doctor daid it was shingles although I never had a rash. Took medicine and it went away. After that I began to have head tremors that I noticed only when I would lay down at night. I can hold my head a certain way when I am up and have them also. Sometimes when I am laying down I feel like my chest is shaking. They have not gotten any worse maybe even better, but I still have them. I am 55, ahve never had any health problem except a borderline low thyroid that I am taking 0.05 mg. snythroid. Doctor checked my tsh and said it was not from that. Neuro didn.t really know. He said it was so mild. But to me it's not so mild, when I am laying there with my head shaking and my veins in my neck jerking. Any  ideas on  what may be wrong with me or what kind of tremors I have?

[Pam]

does it work