A tremor is an unconscious, somewhat rhythmic contraction and relaxation of the muscle, involving oscillatory motion or twitching of one or more parts of the body. This is the most common of all unconscious movements and can affect the hands, arms, eyes, face, head, vocal cords, torso, and legs. Most of the tremor happens in the hand. In some people, tremor is another symptom of neurological disorders. The very common vibrations are chattering teeth, usually caused by cold temperatures or by fear.
Video Tremor
Cause
Tremors can be symptoms associated with disorders in parts of the brain that control muscles throughout the body or in certain areas, such as the hands. Neurological disorders or tremor-causing conditions include multiple sclerosis, stroke, traumatic brain injury, chronic kidney disease and a number of neurodegenerative diseases that destroy or destroy small brain stem cells, Parkinson's disease is most often associated with tremors. Other causes include the use of drugs (such as amphetamines, cocaine, caffeine, corticosteroids, SSRIs) or alcohol, mercury poisoning, or withdrawal of drugs such as alcohol or benzodiazepines. Tremors can also be seen in infants with phenylketonuria (PKU), overactive thyroid failure or liver failure. Tremor may be an indication of hypoglycemia, along with palpitations, sweating and anxiety. Tremors can also be caused by lack of sleep, lack of vitamins, or increased stress. Lack of magnesium and thiamine are also known to cause tremors or tremors, which disappear when deficiencies are corrected. See magnesium in biology. Some forms of tremors are inherited and run in families, while others have no known cause. Tremors can also be caused by multiple spider bites, eg. spiders are redirected from Australia.
Characteristics may include rhythmic vibrations in the hands, arms, head, feet, or body; shaking voice; and the problem of holding items such as forks or pens. Some tremors can be triggered by or become worse during times of stress or strong emotion, when a person is physically exhausted, or during certain postures or movements.
Tremor can occur at any age but most commonly occurs in middle age and elderly. It may be occasional, temporary, or intermittent. Tremor affects men and women equally.
Vibration types
Tremors can be generated from other conditions as well
- Alcoholism , excessive alcohol consumption, or withdrawal of alcohol can kill certain nerve cells, resulting in a tremor known as asterixis. In contrast, small amounts of alcohol may help reduce familial and essential tremors, but the mechanisms behind them are unknown. Alcohol potentiates GABAergic transmission and may act on an inferior olive level.
- Tremors in peripheral neuropathy can occur when the nerves that supply the muscles of the body are traumatized by injury, disease, abnormalities in the central nervous system, or as a result of systemic disease. Peripheral neuropathy can affect the whole body or certain areas, such as the hands, and can be progressive. Resulting sensory loss can be seen as tremor or ataxia (inability to coordinate voluntary muscle movement) of affected limbs and problems with gait and balance. Clinical characteristics may be similar to those seen in patients with essential tremors. The symptoms of
- Withdrawal of tobacco include tremors.
- Most symptoms can also occur randomly when panic .
Maps Tremor
Diagnosis
During a physical exam a doctor can determine whether a tremor occurs primarily during an action or at rest. The doctor will also examine the symmetry of tremors, sensory loss, weakness or muscle atrophy, or decreased reflexes. A detailed family history can indicate if tremors are inherited. Blood or urine tests can detect impaired thyroid function, other metabolic causes, and abnormal levels of certain chemicals that can cause tremors. These tests may also help identify contributing causes, such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging using CT or MRI imaging may help determine whether tremor is a result of structural damage or brain degeneration.
The doctor will perform a neurological examination to assess neurological function and motor skills and sensory. This test is designed to define functional constraints, such as difficulty with handwriting or the ability to hold tools or cups. The patient may be asked to put a finger on the tip of his nose, draw a spiral, or perform other tasks or exercises.
Your doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures unconscious muscle activity and muscle response to nerve stimulation. The selection of sensors used is important. In addition to studying muscle activity, tremors can be assessed with accuracy using the accelerometer.
Category
The level of tremor should be assessed in four positions. The tremor can then be classified by which position best emphasizes tremor:
Treatment
There is no cure for most tremors. Appropriate treatment depends on an accurate diagnosis of the cause. Some tremors respond to treatment underlying conditions. For example, in some cases of psychogenic tremors, treating the underlying psychological problems of the patient may cause the tremor to disappear. Some medications may help relieve temporary symptoms.
Drugs
Drugs remain the basis of therapy in many cases. Symptomatic drug therapy is available for some forms of tremor:
- Parkinsonian tremor drug therapy involves L-DOPA and/or drugs such as dopamine such as pergolide, bromocriptine and ropinirole; They can be harmful, however, because they can cause symptoms such as tardive dyskinesia, akathisia, clonus, and in rare cases tardive (late developing) psychosis. Other drugs used to reduce Parkinsonian tremors include amantadine and anticholinergic drugs such as benztropine
- Essential tremors can be treated with beta blockers (such as propranolol and nadolol) or primidone, anticonvulsants The symptoms of
- cerebellar tremor may decrease with the application of alcohol (ethanol) or benzodiazepine drugs, both of which carry the risk of addiction and/or addiction The patient
- Rubral tremor may receive some help using L-DOPA or anticholinergic drugs. Surgery can help
- Dystonal strain may respond to diazepam, anticholinergic drugs, and intramuscular intrinsic toxin botulinum. Botulinum toxin is also prescribed to treat sound and tremor head and some movement disorders
- Primary orthostatic disorder is sometimes treated with a combination of diazepam and primidone. Gabapentin provides assistance in some cases
- Increased physiological tremor is usually reversible once the cause is corrected. If symptomatic treatment is required, beta blockers may be used
Lifestyle
Eliminating "trigger" tremors such as caffeine and other stimulants from the diet is often recommended. Essential tremor may benefit from a small dose of ethanol, but the potential negative consequences of regular ethanol intake need to be taken into account. Beta blockers have been used as an alternative to alcohol in sports such as playing competitive darts and bringing less potential addiction.
Physical therapy and occupational therapy can help reduce tremors and improve coordination and muscle control for some patients. A physical therapist and/or occupational therapist will evaluate the patient for tremor positions, muscle control, muscle strength, and functional skills. Teaching patients to hold affected limbs during tremors or holding the affected arm near the body is sometimes useful in gaining motion control. Coordination and balance training can help some patients. Some occupational therapists recommend the use of weights, splints, other adaptive equipment, and dishes and special equipment for eating.
Surgery
Surgical interventions such as thalamotomy and deep brain stimulation can alleviate certain tremors. This surgery is usually performed only when the tremor is severe and does not respond to medication. The response can be very good.
Thalamotomy, involving the formation of lesions in the region of the brain called the thalamus, is quite effective in treating patients with essential tremor, cerebellum, or Parkinson's. The procedure at this hospital is done under local anesthesia, with the patient awake. After the patient's head is secured in a metal frame, the surgeon maps the patient's brain to find the thalamus. Small holes drilled through the skull and temperature controlled electrodes are inserted into the thalamus. The low frequency stream is passed through the electrode to activate the tremor and to confirm the exact placement. Once the site has been confirmed, the electrodes are heated to create a temporary lesion. Testing is performed to test the ability to speak, language, coordination, and activation of tremor, if any. If no problem occurs, the probe will be heated again to produce a 3 mm permanent lesion. The probe, when cooled to body temperature, is drawn and the hole of the skull is closed. Lesions cause tremors to disappear permanently without impairing sensory or motor control.
In-brain stimulation (DBS) uses implanted electrodes to transmit high-frequency electrical signals to the thalamus. Electrode implanted as described above. Patients use hand magnets to switch on and off pulse generators grown under the skin. Temporary electrical stimulation can kill the tremor and may "turn over," if necessary, by turning off the planted electrode. The batteries in the generator last about 5 years and can be replaced surgically. DBS is currently used to treat Parkinsonian tremors and essential tremors. It is also successfully applied to other causes of rare tremors.
The most common side effects of tremor surgery include dysarthria (problems with speech motor control), temporary or permanent cognitive disturbance (including visual and learning difficulties), and problems with balance.
Biomechanical loading
As well as medicines, rehabilitation programs and surgical interventions, the application of biomechanical loading on tremor movements has proven to be a technique capable of suppressing the effects of tremor on the human body. It has been established in the literature that most of the different types of tremors respond to biomechanical loading. In particular, it has been clinically proven that increased damping and/or inertia in the upper extremities leads to reduction of tremor motion. Biomechanical loading depends on a passive external device or actively acting mechanically in parallel with the upper extremity to counter tremor movements. This phenomenon raises the possibility of orthotic tremor management.
Starting from this principle, the development of a top-arm non-invasive ambulatory robotic extrusion is presented as a promising solution for patients who can not benefit from drugs to suppress tremors. In this area robotic exoskeleton has emerged, in the form of orthoses, to provide motor assistance and functional compensation for people with disabilities. Orthosis is a usable tool that functions parallel to the affected limb. In the case of tremor management, orthosis should apply damping or inertia load to the selected limb articulation set.
Recently, several studies have shown that exoskeleton can achieve 40% consistent tremor strength reduction for all users, capable of achieving a reduction ratio in the order of 80% tremor strength in certain user joints with severe tremors. In addition, users reported that the exoskeleton did not affect their voluntary movements. These results demonstrate the feasibility of suppressing tremors through biomechanical loading.
The main disadvantages of this mechanical management tremor are (1) the resulting large solution, (2) inefficiency in the load transmission of the exoskeleton to the human musculo-skeletal system and (3) technological limitations in terms of actuator technology. In this case, the current trend in this area is focused on evaluating the biomechanical loading concept of tremors through selective Functional Electrical Stimulation (FES) based on Brain-to-Computer Interaction (BCI-driven) detection of motor (tremor) activity.
See also
- chronic induced encephalopathy
- Fasciculation Ã, twitches this from "at rest" the skeletal muscle is too weak to cause joint motion, and falls short of the definition of vibration. It is usually benign, but it is also a symptom of some very serious neurological disorders such as ALS (although rarely such disorders begin with fasciculations only).
- Neurology
- Restless Leg Syndrome
- Shiver
References
External links
- "NINDS Tremor Information Page". National Institute of Neurological Disorders and Stroke. July 20, 2007 . Retrieved 2007/10/08 Ã, Some text copied with permission and thanks.
- "Leonid L. Rubchinsky et al. (2007) Tremor". Scholarpedia .. 2 (10): 1379. doi: 10,4249/scholarpedia.1379
- orthostatictremor.org
Source of the article : Wikipedia
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