Parkinson’s Tremor
Parkinson’s tremor is characterised by uncontrollable shaking that affects a part or parts of the body (for example, the hand).
It’s one of the main symptoms commonly associated with Parkinson’s disease (PD), a progressive neurological disease that affects the brain.
Around 153,000 people in the UK are living with Parkinson’s disease. For many, dealing with the symptoms of Parkinson’s tremor is a daily battle. Although Parkinson’s tremor is not typically disabling, it can make it challenging to carry out everyday activities, and many people experience high levels of anxiety and embarrassment about their condition.
Testing for Parkinson’s tremor
What’s the difference between Parkinson’s tremor and essential tremor?
Coping with Parkinson’s tremor
Taking control of Parkinson’s tremor
What is Parkinson’s tremor?
Parkinson’s disease is a complex condition that presents differently in every individual. If you have been diagnosed with PD, your journey will be entirely unique to you.
Not everyone with Parkinson’s experiences Parkinson’s tremor. For many individuals, however, tremor is the first symptom they experience, often appearing in the hand or foot. Over time, it can spread to other body parts, often asymmetrically. Tremor-dominant Parkinson’s is when tremor is your main symptom that needs management.
Tremor is the most well-known symptom of Parkinson’s disease, with approximately 70–90% of people with PD experiencing tremor at some point in their life. Together with slowness of movement (bradykinesia) and rigidity, it makes up the three most common motor symptoms affecting individuals with Parkinson’s.
Parkinson’s tremor can be experienced in several different ways.
Resting tremor
A Parkinson’s tremor is more likely to appear as a resting tremor, which means it happens while the body is at rest. One of the most common examples of resting tremor is called a ‘pill-rolling’ tremor because it appears as if you are trying to roll a pill between your thumb and index finger.
Action tremor
An action tremor (kinetic tremor) is when you experience trembling or shaking when trying to do something, such as drink from a cup or sign your name.
Internal tremor
If you experience an ‘internal tremor’, you may feel trembling or shaking inside your chest, abdomen or limbs. This symptom is unnoticeable to outside observers.
Parkinson’s tremor symptoms
Parkinson’s tremor is an involuntary movement that can present as shaky hands or feet, twitching or slow and continuous trembling.
Parkinson’s tremor commonly begins in a hand or foot and then progresses to other body parts on the same side of the body. It tends to spread asymmetrically, although as Parkinson’s progresses, both sides of the body may become affected by tremor.
If you have tremor-dominant Parkinson’s, the most commonly affected body parts are the hands, feet and legs. In more severe cases, it can affect your lips, tongue or jaw, causing the whole head to shake.
Testing for Parkinson’s tremor
There isn’t one definitive test or exam for Parkinson’s disease, so your medical team will have to rely on your medical history, symptoms and a physical exam to make a diagnosis. In its early stages, symptoms are often mild, and it may take some time to receive a diagnosis for PD or another neurological condition.
If you have been experiencing tremor symptoms, your GP will likely refer you to a neurologist who specialises in conditions of the brain and nervous system.
Sometimes, your neurologist might suggest a dopamine transporter scan (DaTSCAN). This imaging technology allows neurologists to visualise the dopamine system in the brain. If your DaTSCAN reveals a reduced function of the dopamine system in the part of the brain responsible for controlling movement, it could confirm a diagnosis of Parkinson’s.
It’s important to note that although DaTSCANs can be helpful during the diagnosis process, it is not a definitive test for diagnosis. If your history, symptoms and physical exam meet the criteria for a Parkinson’s diagnosis, a DaTSCAN may not be necessary.
What’s the difference between Parkinson’s tremor and essential tremor?
Whilst tremor is a common symptom of Parkinson’s, it can also be a symptom of other movement disorders, most notably essential tremor (ET). Essential tremor is sometimes confused with Parkinson’s disease, but it is 8–10 times more common than Parkinson’s.
Involuntary tremors characterise both Parkinson’s tremor and essential tremor, but there are key differences between these two neurological movement disorders.
| Parkinson’s disease (PD) | Essential tremor (ET) |
|---|---|
| Tremors are mostly commonly experienced while at rest (rest tremor). | Tremors are primarily experienced in action (kinetic and postural tremors). |
| Tremors affect the arms, legs, chin and jaw. The voice and head are rarely affected. | Tremors primarily affect the hands, head, voice and, less commonly, the legs. |
| PD tends to affect the body asymmetrically. It typically starts on one side and progresses to the other. | ET affects both sides of the body, although not in the same manner. |
| A family history of PD is present in less than 10% of cases. | A family history of ET is common. |
| The average onset is between 55-65. | Onset typically occurs after 40 but can occur in individuals of all ages, even in infancy. |
| PD can also cause general slowness (bradykinesia), stiffness, difficulty walking and poor balance. | The level of disability varies among individuals. Some might experience an unsteady walk, but this is less common. |
| The condition can be worsened by stress or anxiety. | The condition can be worsened by stress or anxiety. |
You can visit our page on essential tremor to learn more about the symptoms, causes and treatment of the condition.
Parkinson’s tremor treatment
While there is no cure for Parkinson’s tremor, there are treatment options that can help manage the symptoms.
Because Parkinson’s disease affects everyone differently, you should discuss a personalised treatment plan with the help of a multidisciplinary team.
Medication
Medication is the first line of therapy for Parkinson’s tremor. The most commonly used medication is levodopa (also known by the brand names of Sinemet and Madopar, among others). Levodopa can be very effective in controlling the symptoms of Parkinson’s tremor, but over time, as the tremor worsens, the medication’s effectiveness can decrease.
Other drugs that can improve Parkinson’s tremor include:
- Dopamine agonists
- MAO-B inhibitors
- COMT inhibitors
- Amantadine
- Anticholinergics
All medications come with risks of side effects, so it’s essential to plan your medication routine with your healthcare professionals and check in with them frequently to discuss their impact and continuing efficacy.
Deep brain stimulation (DBS)
When medication is no longer effective at controlling your symptoms of tremor, then you may be suitable for deep brain stimulation (DBS), the most common surgical treatment for Parkinson’s disease. DBS can also be an effective method for controlling other motor symptoms of PD, including slowness of movement (bradykinesia), rigidity and involuntary movements (dyskinesia).
In DBS, electrical stimulation is delivered to the brain via an electrode or electrodes implanted in the structures in the brain responsible for movement, such as the thalamus, the globus pallidus and the subthalamic nucleus. The electrodes are connected to a neurostimulator device (similar to a pacemaker) that is implanted in your chest. The neurostimulator then transmits electrical signals to the brain to interrupt the faulty electrical signals in the part of your brain responsible for the motor symptoms.
The surgery is done in two stages:
- First stage: A neurosurgeon makes a precise map of your brain using an MRI or CT scan. Once the appropriate area of the brain is identified, an electrode is implanted into the brain. After the surgery, you will generally have to remain in hospital for 1–2 days.
- Second stage: Roughly 1–2 weeks later, your neurosurgeon will implant the neurostimulator device and battery pack under general anaesthesia. You will typically be able to go home the same day.
It’s important to understand that DBS is not a cure, but it can help to manage your symptoms, improve your day-to-day functioning and reduce your medication.
As with all surgeries, there are risks associated. Deep brain stimulation is major surgery, and it involves implanting foreign objects in the body and brain.
Additional considerations and potential risks for deep brain stimulation include:
- Risk of stroke
- Risk of bleeding inside the skull
- Risk of infection from the parts
The implanted parts can also wear out or wear through the skin, and the battery will need to be replaced every 3–7 years.
MR-guided focused ultrasound (MRgFUS)
Like deep brain stimulation, MR-guided focused ultrasound (MRgFUS) is a surgical option for treating Parkinson’s tremor when you have become less responsive to your medication.
It is an incision-less procedure that combines two technologies — high-intensity focused ultrasound (FUS) is guided by magnetic resonance imaging (MRI) to destroy a small area of tissue in the brain responsible for the tremor.
In focused ultrasound (FUS), a special device focuses the energy from over 1000 ultrasound sources, creating a point of intersection in a very precise spot in the thalamus of the brain. The focused ultrasound waves generate enough heat at this intersection point to create a permanent lesion in the brain tissue, interrupting the circuitry responsible for the tremor. The MRI acts as the ‘eyes’ of the neurosurgeon, allowing them to see the brain in real-time to accurately pinpoint the correct target location and monitor the temperature of the ultrasound waves.
The outpatient procedure takes about 3–4 hours, and you will be conscious throughout the treatment.
Most reported side effects were reported as mild and resolved themselves in 30 days. The most commonly reported side effects were:
- Numbness or tingling
- Imbalance
- Gait disturbance
- Unsteadiness
Learn more about the procedure and its benefits on our MR-guided focused ultrasound for Parkinson’s tremor treatment page.
Coping with Parkinson’s tremor
You can make many lifestyle changes to help you cope with Parkinson’s tremor.
Managing stress
Parkinson’s tremor can get temporarily worse in times of fatigue, stress or anxiety. Many people with PD use complementary treatments to help them manage stress, anxiety and depression.
Complementary therapies can include strategies such as yoga, meditation, aromatherapy, acupuncture or other relaxation techniques. These therapies should not be used in place of your prescribed medication but can be incorporated as part of a holistic approach to your overall physical and mental health and well-being.
Exercise
One of the most significant lifestyle changes that you should prioritise is exercise. Research from the Parkinson’s Outcomes Project has shown that individuals who start exercising earlier in their disease course for at least 2.5 hours per week experience a slower decline in their quality of life.
Exercise can help with balance, strength and coordination, as well as non-motor symptoms such as depression and constipation. An exercise regime should incorporate elements of aerobic activity, strength training, flexibility and balance/agility.
Diet and supplements
Eating a well-balanced diet rich in vitamins and antioxidants can help alleviate some of the symptoms of Parkinson’s disease. If you have Parkinson’s tremor, you have a higher risk of bone fractures, so you may want to speak with your doctor about taking calcium and vitamin D supplements for your bone health.
Assistive technology and devices
As daily tasks become more difficult, you may want to consider incorporating assistive devices into your daily routine. Some tools that can help you live with tremor and make the home safer include bathing and grooming aids, adaptive utensils, dressing aids and wearable technology to help you stay active.
Take control of Parkinson’s tremor
Living with Parkinson’s tremor can make it difficult to perform everyday tasks and impact your quality of life. Although there is no cure, there are treatments that can help.
If you are no longer able to manage your symptoms of Parkinson’s tremor with medication, then you might be a candidate for MR-guided focused ultrasound — a safe and non-invasive treatment for Parkinson’s tremor.
At Queen Square Imaging Centre, you’ll meet with a multi-disciplinary team to discuss all your treatment options and suitability, including MR-guided focused ultrasound.
Learn more about how MR-guided focused ultrasound treatment can help you find relief from Parkinson’s tremor.
