Parkinson’s Tremor

Introduction

Parkinson’s tremor is a movement disorder which occurs when the brain does not produce enough dopamine which leads to brain’s inability to control movements and other muscle functions and occurs when the muscles are relaxed  or when the affected part is at rest. Essential tremor is a neurological condition caused by electrical fluctuations in the brain that sends signals out to the muscles and it occurs when the part of the body is in motion or held in a specific position (Hof & Mobbs, 2001). Both are progressive hence they tend to get worse over time. They cannot be cured but the symptoms can be treated. They are movement disorders in which people have difficulty in movement and both can be worsened by emotional stress.

The conditions are different in a number of ways; essential tremor is hereditary unlike Parkinson’s tremor which rarely has a family history. While Essential tremors (ET) are seen during action, the Parkinson’s occurs at rest. Small amounts of alcohol can reduce essential tremors but have no effect on Parkinson’s.  Levodopa treatment usually improves Parkinson’s tremors while as Essential tremors improves with Primidone and Propranolol treatment. With ET, the hands are mostly affected but tremor is also present in the hand and voice and rarely in the legs but in Parkinson’s tremors, the hands are more affected than the legs with the voice and the head almost never affected (Duvoisin & Sage, 2001).

Treatment plans for the tremors depends on the degree of impairment.  Medications for Essential tremors include adrenergic blockers, such as Propranolol and Primidone. Since stress worsens the tremors, non-medical relaxation techniques can be applied. Surgery can also be done in patients with significant functional impairment. Parkinson’s tremor treatment options include medications, exercise, speech therapy and surgical treatment with deep brain stimulations for those with advanced tremors. Levodopa is the most effective drug in treating the symptoms associated with Parkison’s tremors. Dopamine agonists are used in the initial treatment of the symptoms of the tremors (Duvoisin & Sage, 2001).

History and physical examination are important while diagnosing. Electromyography is also done to check the electrical activity of muscles. History reveals that essential tremors occur in early childhood and it occurs during actions mostly seen in the wrists and hands. Diagnosis of essential tremor can be ascertained by a therapeutic trial of alcohol. Parkinson’s tremor mostly occurs at rest and is characterized by bradykinesia (slowness of movement), rigidity and muscle stiffness.

Health restoration and improvement in quality of life for patients with these diagnoses can be done through providing relief from the symptoms associated with tremors since there is no cure for them. Since not every treatment is effective for every person, it is important to give an individualized treatment plan. Lifestyle changes such as exercise, relaxation techniques such as taking deep breaths can go a long way in reducing the tremors because stress and anxiety worsen the tremors. Maintaining the arms as close in to the body is a strategy that can help those with Parkinson’s tremor since proximal stability provided to an affected arm can reduce the tremors during functional activities. Adaptive equipment such as button hooks can reduce Parkinson’s tremor by increasing fine motor skills. Providing a stable surface for affected arm reduce the Essential tremors and use of weighted devices such as arm cuffs can also manage the tremors during functional activities (Hof & Mobbs, 2001).

References

Duvoisin, R. C., & Sage, J. (2001). Parkinson’s disease: A guide for patient and family. Philadelphia: Lippincott Williams & Wilkins.

Hof, P. R., & Mobbs, C. V. (2001). Functional neurobiology of aging. San Diego, CA: Academic Press.