Monday, August 1, 2011

Causes of Tremor

When people come into my office with a tremor, they 90% of the time want to know one thing: Do I have Parkinson's Disease?

I think that people should know the list of things that cause tremor, so they know what all needs to be considered depending on their history, physical exam, and any testing that needs to be done.

By the way, there is NO test for Parkinson's Disease. Tests can help rule out other things to hone in on a diagnosis of Parkinson's, but nothing can test for it directly at this time in Modern Medicine. It is a clinical diagnosis, which means you have to trust whomever you choose as your care provider.

Things that cause tremor in no particular order of frequency:

Parkinson's Tremor (Discussed in a separate post)

Essential Tremor (Discussed in a separate post)

Enhanced Physiologic Tremor (every human has a natural physiologic tremor which is usually not visible), but it can be worsened by things such as chronic anxiety, hypoglycemia or other metabolic things, etc... or it just happens. Yes, sometimes it just happens, but if we decide this is the reason (an unknown cause for your enhanced physiologic tremor), the prognosis is usually good that it will level off at some mild degree and not need treatment

Medications (Lithium, Valproate/Depakote, excessive caffeine use, amphetamines/stimulants used for ADD or excessive sleepiness, cocaine, anti-psychotics, corticosteroids for autoimmune diseases...)


Strokes in the cerebellum (the back part of the brain responsible for balance and coordination)

Damage to the basal ganglia from such things as strokes, or excessive calcification, etc (a deep complex structure in the brain responsible for smoothing out our initiated movements among other things)

Liver disease

Heavy metal poisoning

Multiple Sclerosis

Alcohol abuse, or withdrawal from it

Wilson's Disease

Psychogenic tremor (found in people due to stress, as their mind-through-body's way of calling out)

Orthostatic tremor (usually in legs or trunk immediately after standing- can be associated with cramps)

As a manifestation of dystonia, and causes of dystonias is itself a long list

Peripheral neuropathy, and, again, the causes of this are a long list as well potentially