Overview
Tremor is a rhythmic or regular back-and-forth movement (trembling or shaking) of one or more parts of your body. Tremor can affect your:

• Hands/arms
• Feet/legs
• Trunk (mid section)
• Head
• Face/jaw/chin
• Voice
• Tongue

People who have tremors cannot control the movement. Tremors may begin at any age. In some people, tremor may come on suddenly. In others, it may start slowly and get worse over many months or years. Stress, nervousness, and illness make most tremors worse. Most tremors go away during sleep. Tremors may occur when you are:

• Resting and not using the part of your body that has tremor
• Holding your body part out, such as holding your arm or leg out in front of you
• Moving, such as when you are using your body part to do an activity like writing or eating

Causes
Most tremors are caused by problems in the brain. There are more than 20 different kinds of tremors. Essential tremor is the most common type of tremor and generally occurs during activities such as writing, eating, or dressing. It may be passed from parent to child. Tremor may be caused by certain medicines, such as those used to treat attention problems or asthma. Some tremors are linked to other conditions, such as:

• Parkinson's disease
• Dystonia
• Thyroid problems
• Multiple sclerosis
• Wilson's disease (trouble removing copper from the body)
• Liver failure
• Injury to the brain

Diagnosis
It can be difficult to determine the cause of your tremor. The doctor will ask you many questions and will watch your tremor to see what parts of your body are affected, if your tremor is constant or comes and goes, how fast and how strong your tremor is, and if you have any symptoms other than tremor. Based on your answers and what the doctor sees, tests may be done to find out what is causing your tremor, such as taking a picture of your brain to see if there has been an injury or testing your blood to find out if another condition is causing your tremor.

Your answers to your doctor's questions will help your doctor decide which tests will be needed. Some questions might be:

• Did your tremor start all at once or slowly?
• Do other family members have a tremor?
• In what parts of your body do you have tremor?
• Is your tremor worse during activities such as writing, eating, or dressing?
• Does your tremor go away when you drink alcohol?
• What makes your tremor worse?
• Do you have other symptoms besides tremor, such as problems with walking or balance?
• Has your handwriting changed?
• Have you had a head injury?
• What medicines are you taking?

Your doctor will want to know how your tremor affects your life, such as eating, dressing, and writing. Your doctor may ask you to:

• Draw a spiral
• Write a few sentences
• Pour water from one glass to another glass
• Hold a full cup of water for one minute
• Read a few lines from a paper or book

Treatment
If your tremor is related to another condition, the first step is to treat your other condition. If you are taking medicines that make your tremor worse, your doctor may change how much medicine you are taking or switch you to a different medicine. You should not change your medicine without your doctor telling you to do so.

Not all tremors need to be treated. If your tremor bothers you or keeps you from doing things that you want to do, you and your doctor can work together to decide what is the best choice for you, which may include:

• Common medicines that you take by mouth including a beta blocker such as propranolol, certain anticonvulsants such as primidone (Mysoline®), gabapentin (Neurontin®), or topiramate (Topamax®); or benzodiazepines such as clonazepam (Klonopin®), diazepam (Valium®), alprazolam (Xanax®), or others.
• Injection therapy with botulinum toxin type A (BOTOX®) or type B (Myobloc™) which is injected into various muscles to block the signals that are causing the tremor
• Brain surgery, if medications do not work for you and your tremor interferes with your daily activities such as writing, eating, and dressing. The most common surgery, called deep brain stimulation (DBS), places thin wires into the brain, which are connected to a small pacemaker that delivers very small electrical pulses to block the tremor. An alternative form of surgery, called lesioning or ablation, destroys a tiny portion of the brain to prevent tremor.

Questions to Ask Your Doctor

• Is there anything that I can do by myself to make my tremor better?
• Do I need treatment for my tremor?
• What are the side effects and benefits of treatment?
• How can I contribute to research studies on tremor?

If you would like more detailed information on the symptoms, diagnosis, and treatment options or additional support (such as discussion forums and chat rooms), please visit www.wemove.org.