Shaky hands syndrome doesn't necessarily mean Parkinson's disease. What could be behind it?

When you notice involuntary shaking of your hands (or, as doctors say, a tremor), the first thing you would think of is that it indicates the onset of Parkinson's disease. But this is not always the case. However, trembling hands, especially if it is noticeable to others, can cause a lot of trouble, including psychological discomfort.

So what could cause my tremor, and how can I find it out?

In shivering, muscle tension and relaxation change very quickly, and a person cannot control them. Such a reaction is often caused by nervous tension, which is quite normal. For example, if you need to make a speech in the presence of a large number of people. It can also be triggered by cold. But when such circumstances are over - the speech is made, you’ve come back into a warm room and warmed up, etc., the shiver disappears completely and we forget about it.

But what if your hands suddenly start shaking without any external cause? What if it happens again and again? Such manifestations are a serious concern. The main issue is the possible onset of Parkinson's disease. And, if a comprehensive examination by a neurology specialist gives a negative answer, it is necessary to consider other probable causes of such a condition. And these can be very diverse.

If it's not parkinsonism, what is it?

Experts name a number of circumstances and diseases that can be manifested by repeated involuntary hand tremor.

It can also be caused by various medications, such as psychopharmacological drugs, as well as medicines given for bronchial asthma or epilepsy. 

Changes in the nervous system associated with diabetes mellitus or kidney disease can also lead to hand tremors. Another option is the manifestation of vitamin B12 or calcium deficiency.

Also, uncontrollable hand tremor is sometimes observed in various kinds of cerebellar disorders, especially with years of alcohol abuse.

What should you do if the symptom recurs while Parkinson's disease has been ruled out?

Shaking of the hands or other body parts, especially at their peak, should be videotaped, for example, on your phone. This recording can be of invaluable help in future diagnosis.

Such a step will help to identify what is wrong, possibly suggesting a direction for further action and a specialist whom you should see about the issue. Specialized centers offer full body check-ups which are very compact in terms of time, literally taking just a few hours. This helps to avoid unnecessary visits to various doctors, which are time-consuming and may bring no results anyway.

Based on his many years of experience, Prof. Ceballos-Baumann sates that finding the possible cause of the tremor is the most important step in solving the problem. If the cause is known, changes in the current drug treatment regimen (its dosage or active ingredient) can eliminate the tremor completely, or significantly reduce it. Or it could be achieved by treating a newly identified condition.

Treatment strategy should better be entrusted in doctors with the appropriate subspecialty

Alas, it does not always become immediately clear what exactly lies behind such a symptom as tremor. And since the issue is quite common, there are specialized medical facilities that focus on it. They take care of patients in whom all possible obvious causes of tremor have been excluded.

According to his data, the most common is the so-called essential tremor. Thereby the nervous system disorders are manifested, for example, by trembling of the hands when writing or when holding a glass. When the hands are relaxed, it is not present.

Rest tremor looks different: it is manifested when the body parts are relaxed, for example, if the hand is just lying on the table. With increased physiologic tremor, the frequency of shaking movements increases sharply.

Another type - intension - is manifested by tremor during movement, for example, before the hand touches the object which it intends to reach.

There are many special tests that allow you to clarify the nature of tremor and develop customized treatment strategies. Sometimes it is enough to learn special relaxation techniques, in other cases it may become necessary to take medications. In extremely rare situations, a surgical procedure including implantation of a brain pacemaker may be indicated.   

Long-term lifestyle and nutritional recommendations and an customized monitoring plan can be obtained from a healthcare specialist.

In any case, repetitive tremor in the hands or other body parts, which has no clear cause, should not be ignored, and requires the most thorough search for its causes.  

References

1. AZ-Interview, Andrés Ceballos-Baumann. "Zittern spielt nur bei 50 Prozent eine Rolle". 11. April 2021 - 08:07. https://www.abendzeitung-muenchen.de/
2. Wenn die Hände zittern: Was hinter einem Tremor stecken kann. 17.05.2022, 10:00. https://www.geo.de/