In this article:

• What is a rest tremor?
• What causes a rest tremor?
• Rest tremor and Parkinson’s Disease
• Rest tremor vs Essential Tremor
• Symptoms of rest tremor
• Diagnosing rest tremor
• Treatment options for rest tremor
• Advanced targeting with FAT1 imaging
• Rest tremor treatment in London

A tremor is a rhythmic, involuntary shaking movement affecting part of the body. Tremors can occur for a variety of reasons, including anxiety, stress, fatigue or excess caffeine intake, but they can also be caused by neurological conditions such as Parkinson’s disease or essential tremor (ET).

A rest tremor occurs when a part of the body is fully relaxed and supported against gravity. It is one of the most recognisable symptoms of Parkinson’s disease, although not everyone with Parkinson’s develops a tremor, and not every rest tremor is caused by Parkinson’s.

Rest tremor most commonly affects the hands and fingers, but it can also involve the arms, legs, jaw, chin or lips. In many cases, symptoms begin on one side of the body before gradually progressing over time.

For some people, rest tremor is mild and intermittent. For others, it can significantly affect confidence, daily activities, work and quality of life.

What is a rest tremor?

A rest tremor occurs when muscles are relaxed and not being used voluntarily. Symptoms often improve or temporarily disappear during purposeful movement.

This differs from action tremor, which is usually most noticeable when moving or while maintaining a posture, such as holding a cup or writing.

A rest tremor is often described as a “pill-rolling” tremor because the movement of the thumb and fingers can resemble rolling a small object between the fingers.

In Parkinson’s disease, rest tremor is often:

• Slow and rhythmic
• More noticeable when relaxed or distracted
• Initially unilateral (affecting one side)
• Reduced during voluntary movement
• More prominent during stress, fatigue or anxiety

What causes a rest tremor?

The most common neurological cause of rest tremor is Parkinson’s disease. Parkinsonian tremor is caused by disruption to brain circuits involved in movement control, particularly those linked to dopamine production and signalling.

However, rest tremor can occasionally occur in other situations, including:

• Medication side effects
• Multiple sclerosis
• Brain injury or stroke
• Other neurological movement disorders such as dystonia

In some people, a rest tremor may occur for many years without developing the full features of Parkinson’s disease.

Rest tremor and Parkinson’s disease

Rest tremor is one of the cardinal motor symptoms of Parkinson’s disease, alongside:

• Slowness of movement (bradykinesia)
• Muscle stiffness (rigidity)
• Balance or walking difficulties

Parkinsonian tremor usually begins asymmetrically, affecting one hand or arm first before potentially progressing to the other side over time.

Although tremor is common in Parkinson’s disease, not everybody develops it. Some patients primarily experience stiffness or slowness rather than shaking.

Parkinson’s disease can also cause a range of non-motor symptoms, including:

• Reduced sense of smell
• Constipation
• Sleep disturbance (dream enactment)
• Anxiety or depression
• Fatigue

Because symptoms can overlap with other movement disorders, assessment by a neurologist specialising in movement disorders is important to ensure an accurate diagnosis.

Rest tremor vs essential tremor

Rest tremor and essential tremor are different conditions, although they are sometimes confused.

Rest tremor typically:

• Occurs when relaxed
• Improves during movement
• Is commonly associated with Parkinson’s disease
• Often starts on one side

Essential tremor usually:

• Occurs during movement or activity
• Worsens when holding a posture
• Commonly affects both hands
• Often runs in families

Essential tremor is generally considered an action tremor, whereas Parkinsonian tremor is classically a rest tremor. There can be overlap.

Symptoms of rest tremor

Symptoms can vary between individuals but commonly include:

• Tremor in the fingers, hands or arms
• “Pill-rolling” finger movements
• Tremor that improves during activity
• Symptoms beginning on one side
• Tremor worsened by stress or fatigue
• Tremor involving the jaw, chin or legs
• Difficulty with handwriting or fine motor tasks

For some people, symptoms remain stable for years. For others, tremor may gradually progress over time

Diagnosing rest tremor

Diagnosis usually begins with a detailed medical history and neurological examination.

A neurologist will assess:

• Whether the tremor occurs during rest or movement
• Tremor frequency and severity
• Distribution of symptoms
• Associated neurological symptoms
• How symptoms affect daily activities

Clinic-based assessments such as handwriting tests or spiral drawing may help evaluate tremor severity.

Depending on the clinical presentation, additional investigations may occasionally be used to exclude other causes. These can include:

• Blood tests
• MRI scans
• CT scans
• Electromyography (EMG)
• Specialist imaging such as DaTscan or SPECT imaging
• Genetic tests

Treatment options for rest tremor

Treatment depends on the underlying cause of the tremor, symptom severity and how significantly symptoms affect daily life.

Medication

Medication is often the first-line treatment for Parkinsonian tremor.

Common medications may include:

• Levodopa
• Dopamine agonists
• Anticholinergic medications
• Beta-blockers in selected cases

Some patients experience significant improvement with medication, while others continue to experience disabling tremor despite medical therapy.

Advanced tremor treatments

For selected patients with medication-resistant tremor, advanced procedural treatments may be considered.

Deep brain stimulation (DBS)

Deep brain stimulation is an established treatment for Parkinson’s disease and tremor disorders.

The procedure involves implanting electrodes into targeted areas of the brain connected to a battery device placed under the skin of the chest. Electrical stimulation helps regulate abnormal brain activity associated with tremor.

One advantage of DBS is that stimulation settings can be adjusted over time as symptoms change.

Radiofrequency ablation (RFA)

Radiofrequency ablation uses heat generated by radio waves to create a small, controlled lesion in a targeted area of the brain involved in tremor pathways.

The procedure can be effective in carefully selected patients, although potential risks include speech, balance or coordination difficulties.

MR-guided focused ultrasound (MRgFUS)

MR-guided focused ultrasound thalamotomy is an incisionless treatment option for selected patients with tremor-dominant Parkinson’s disease or essential tremor.

The procedure uses focused ultrasound energy, guided in real time by MRI imaging, to create a precise lesion within the thalamus – a structure involved in tremor circuits.

Patients remain awake throughout treatment so the clinical team can assess tremor improvement during the procedure itself.

Many patients experience significant tremor reduction during or shortly after treatment, although outcomes and potential side effects vary between individuals.

At Queen Square Imaging Centre in London, patients are assessed by a specialist movement disorder and functional neurosurgery team with expertise in advanced tremor therapies including MR-guided focused ultrasound, DBS and lesioning procedures.

As with all procedural treatments, these interventions carry potential risks and side effects which are discussed carefully during specialist assessment.

Advanced targeting with FAT1 imaging

During MR-guided focused ultrasound, the target area for treatment is usually the Ventral Intermediate Nucleus (Vim) of the thalamus.

FAT1 imaging is an advanced MRI-based imaging technique that combines high-resolution anatomical MRI with diffusion tractography to support more individualised treatment targeting in selected patients.

This approach may help improve target visualisation based on each patient’s unique brain anatomy rather than relying solely on standard anatomical coordinates.

Frequently asked questions about rest tremor

Rest tremor treatment in London

If you develop a persistent rest tremor or other movement symptoms, it is important to seek assessment from a neurologist specialising in movement disorders.

Queen Square Imaging Centre in London offers specialist assessment and advanced treatment options for tremor disorders, including MR-guided focused ultrasound thalamotomy. Our multidisciplinary team works closely with experts in functional neurosurgery and movement disorders to provide personalised treatment recommendations for each patient.

Contact us today to begin your journey.

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