Tremor – involuntary rhythmic oscillatory movements of the body or its individual parts.

Tremor can be physiological or pathological.

Physiological tremor

Physiological tremor is also inherent in healthy people, but its amplitude is so small that it is traditionally invisible.

Physiological tremor increases with excitement, anxiety, overwork, hypothermia, alcohol withdrawal, thyrotoxicosis, hypoglycemia, intoxication, under the influence of certain drugs (lithium products, valproic acid, neuroleptics, tricyclic antidepressants, psychostimulants, caffeine, aminophylline, amiodarone, cimetidine).


Treatment of increased physiological tremor includes exposure to the underlying disease, avoidance of provoking factors (such as coffee or tea), the use of propranolol (anaprilin).

Pathological tremor

Pathological tremor occurs in three main variants, which differ in relation to movement: resting tremor, postural (postural) and kinetic tremor.

Resting tremor is characteristic of parkinsonism and is combined with its other manifestations. Postural tremor occurs when holding a posture, for example, observed in outstretched arms. Predominantly postural character has an enhanced physiological tremor and essential tremor. Increased physiological tremor is observed with excitement, alcohol withdrawal, thyrotoxicosis, hypoglycemia, intoxication, abuse of tea and coffee, and taking certain medications.

Essential tremor is a slowly progressive neurodegenerative disease, the main manifestation of which is a bilateral postural tremor in the hands. In addition to the hands, the tremor can involve the head (trembling like “yes-yes”, “no-no”), vocal cords, legs. In about 60% of cases, the disease is familial, transmitted in an autosomal dominant manner.

Family cases are more often manifested in the 3rd-4th decade of life (traditionally up to 60 years). Sporadic cases are clinically indistinguishable from familial cases, but tend to debut later. Although essential tremor is not often misdiagnosed as Parkinson’s disease, it is not difficult to distinguish between the two diseases in the majority of cases. Unlike Parkinson’s disease, essential tremor has a longer and more benign course, there are no other manifestations of parkinsonism, trembling is most pronounced not at rest, but when holding a pose or moving.


Head tremor is also of differential diagnostic value, which is often noted in essential tremor and very rarely in Parkinson’s disease.

Kinetic tremor occurs or increases dramatically with movement. A variation of kinetic tremor is an intentional tremor that occurs and rapidly increases in the arms or legs when approaching the target and is detected during finger-owl or knee-heel tests. Intention tremor is characteristic of lesions of the cerebellum.

The occurrence of pronounced postural and kinetic tremor in a patient under 50 years of age requires the exclusion of hepatolenticular degeneration.


For the treatment of essential tremor, use (3-blockers (propranolol, 60-240 mg / day), jav primidots (hexamidine), 62.5-500 mg / day, clonazepam, 2-4 mg / day, or a combination thereof.

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