Tremor

Definition

• Tremor is an entity, often belonging to UMN disease.
• Tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts.
• It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs.
• Tremor is classified as a Hyperkinetic movement disorders. Tremor as a disorder classified into some other disorder.
• I think it is better to consider tremor in two different meaning
  1. An entity
  2. A diseases that contain tremor as one of their entities.

Tremor disease

Cerebellar tremor =  Intention tremor

• It is a slow, broad tremor of the extremities that occurs at the end of a purposeful movement, such as trying to press a button or touching a finger to the tip of one's nose.
• It is caused by Cerebellum lesions resulting from stroke, tumor, MS, Inherited degenerative disorder, Overuse of Drugs/ Alcohol
• In classic cerebellar tremor, a lesion on one side of the brain produces a tremor in that same side of the body that worsens with directed movement.

Dystonic tremor

• It occurs in individuals of all ages who are affected by dystonia
• Dystonic tremor may affect any muscle in the body and is seen most often when the patient is in a certain position or moves a certain way.
• The pattern of dystonic tremor may differ from essential tremor.
• Dystonic tremors occur irregularly and relieved by complete rest.
• Touching the affected part may reduce tremor severity (a geste antagoniste).
• Tremor may be the initial sign of dystonia localized to a particular part of the body. It has usually a frequency of about 7 Hz.

Miasmatic analysis

Tremor + Rigidity: JE, RBS, WNE

Remedies: Phos, Sul, Bell, Cupr

Essential tremor = Benign essential tremor

• It is the most common of the more than 20 types of tremor.
• Although the tremor may be mild and non-progressive in some people, in others, the tremor is slowly progressive
• Hands are most often affected but the head, voice, tongue, legs, and trunk may also be involved.
• Head tremor may be seen as a vertical or horizontal motion.
• It may be accompanied by mild gait disturbance.
• Tremor frequency may decrease as the person ages, but the severity may increase, affecting the person's ability to perform certain tasks or activities of daily living. Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may trigger tremors or increase their severity. Onset is most common after age 40, although symptoms can appear at any age. It may occur in more than one family member. Children of a parent who has essential tremor have a 50 percent chance of inheriting the condition.
• Essential tremor is not associated with any known pathology. Its frequency is between 4 and 8 Hz.

Orthostatic tremor

• It is characterized by fast (>12 Hz) rhythmic muscle contractions that occur in the legs and trunk immediately after standing.
• Cramps are felt in the thighs and legs and the patient may shake uncontrollably when asked to stand in one spot.
• No other clinical signs or symptoms are present and the shaking ceases when the patient sits or is lifted off the ground. The high frequency of the tremor often makes the tremor look like rippling of leg muscles while standing.
• Orthostatic tremor may also occur in patients who have essential tremor, and there might be an overlap between these categories of tremor.

Miasmatic analysis

Tremor +

Parkinsonian tremor

• It is caused by damage to structures within the brain that control movement.
• This resting tremor, which can occur as an isolated symptom or be seen in other disorders, is often a precursor to Parkinson's disease (more than 25 percent of patients with PD have an associated action tremor).
• The tremor, which is classically seen as a "pill-rolling" action of the hands [1] that may also affect the chin, lips, legs, and trunk, can be markedly increased by stress or emotion. Onset is generally after age 60. Movement starts in one limb or on one side of the body and usually progresses to include the other side. The tremor's frequency is between 4 and 6 Hz.

Miasmatic analysis

• Tremor + Rigidity + Bradykinesia: WNE
• Tremor + Rigidity + Ataxia: WNE, JE

Physiological tremor

• It occurs in every normal individual and has no clinical significance. It is rarely visible and may be heightened by strong emotion (such as anxiety or fear), physical exhaustion, hypoglycemia, hyperthyroidism, heavy metal poisoning, stimulants, alcohol withdrawal or fever. It can be seen in all voluntary muscle groups and can be detected by extending the arms and placing a piece of paper on top of the hands. Enhanced physiological tremor is a strengthening of physiological tremor to more visible levels. It is generally not caused by a neurological disease but by reaction to certain drugs, alcohol withdrawal, or medical conditions including an overactive thyroid and hypoglycemia. It is usually reversible once the cause is corrected. This tremor classically has a frequency of about 10 Hz.

Psychogenic tremor = Hysterical tremor

• It can occur at rest or during postural or kinetic movement. The characteristics of this kind of tremor may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction and/or body part affected, and greatly decreased or disappearing tremor activity when the patient is distracted. Many patients with psychogenic tremor have a conversion disorder (see PTSD) or another psychiatric disease.

Rubral tremor

• It is characterized by coarse slow tremor which is present at rest, at posture and with intention.
• This tremor is associated with conditions which affect the red nucleus in the midbrain, classically unusual strokes.

Related entities

• Fasciculation
• Myoclonus
• Twitching

Miasms

1. SAHF, STLE
2. CXA/CXB/ECHO, EER/ WEE, GSS, JE, KRU, TBE, VZV, WNE
3. FFI, RBS

Remedies

			Concomitants
Top Essential Tremors Remedy	Zinc	Tremors of hands, feet and head, all limbs or sometimes the entire body. Constant shaking of hands Jerking of hands esp while writing Head tremors, esp from side to side Trembling in feet during walking Emotional excitement (Anger, Joy, Sadness) agg	Weak constitutions (Excessive weakness of hands.) Very sensitive to noise
Hands, Legs, Head, Tongue	Agar	Shaking of hands esp in holding objects, often results in dropping of objects Head tremors that can be constant. Essential Trembling of tongue resulting in unclear speech. Trembling of legs. Jerking of eyelids	Accompanied by a feeling of excessive coolness in the head Weakness and anxiety in general. White coated tongue along with an increased thirst for water along with trembling of tongue
All Limbs	Lol	Shaking of all limbs Difficulty holding objects like a glass or a cup due to shaky hands Trembling in the hands while writing. Gait becomes unsteady.	Limbs also appear cold to touch
Tremors + Weakness	Gels	Tremors are intensified by emotional excitement or fear. Essential tremors of limbs and tongue.	Trembling of the affected part + Excessive muscle weakness. Profound dullness and drowsiness.
Tremors when Using Hands	Sil	Essential tremors of hands when using them. Difficulty in doing fine work due to excessive shaking of hands esp threading a needle	Nervous, anxious, irritable, obstinate
Tremors Of Limbs Worse From Exertion	Phos	Essential tremors that worsens from exertion. Hand tremors esp after exertion Excessive shaking of hands poses great difficulty in holding anything.	Numbness or crawling sensation in hands
Hand And Tongue	Plb	Essential tremors of hand agg from hand movement, holding an object, eating or writing. Trembling of tongue occurs when protruding it out or while talking. Agg by fear or any other emotional excitement.
Head	Lyc	Involuntary, causeless shaking of the head is accompanied by dizziness. Motion of the head is either be from side to side or backward and forward
Tongue and Shaking of Voice	Lach	Excessive shaking of tongue. Tongue is dry, red and swollen. Shaking of the tongue agg when protruding out from the mouth and it can be bitten off with teeth.
Hands, Neck, Legs And Tongue	Merc	Tremors mostly begin in fingers. Due to shaky hands, there is inability to lift or carry anything with hands. There is difficulty in eating with hands and drinking water without spilling. Tremors of neck and legs.	Hand trembling is attended with marked weakness. Excessive trembling of the tongue which is accompanied by profuse saliva in the mouth