Tremor related to degenerative brain conditions
Tremor is rhythmic, involuntary shaking. In Parkinson’s disease, it typically appears as a ‘resting tremor’.
Key points
- Parkinson’s tremor occurs at rest when a limb is relaxed and supported. The tremor typically lessens or disappears with purposeful movement. It usually starts on one side of the body, often in a hand, and may look like the fingers are rolling a small object (a ‘pill-rolling’ tremor).
- Occasionally, tremor may involve the lips, jaw or legs. Patients sometimes report a sensation of ‘internal shakiness’ that isn’t always visible to others, and the tremors may worsen with stress, anxiety or excitement.
- Essential tremor is different from the tremor associated with Parkinson’s disease. It is a more common condition that causes shaking mainly during movement or when holding a position, and it is not regarded as a sign of future Parkinson’s disease.
- Anxiety, stimulants (caffeine), certain medications, low blood sugar and thyroid problems can all cause a normal tremor to become more noticeable.
Not everyone with Parkinson’s disease develops a visible tremor. As many as twenty five per cent may have no tremor, and not everyone with a tremor has Parkinson’s disease.
Next steps:
Tremor does not always indicate Parkinson’s disease. Essential tremor is a separate, more common neurological condition that is often confused with Parkinson’s disease but behaves quite differently.
| Feature | Parkinson’s tremor | Essential tremor |
|---|---|---|
When it appears | At rest | During movement or when holding a position (eg holding a cup, writing) |
Typical starting point | One hand, often asymmetric | Both hands, often more symmetric |
Head involvement | Rare | Can cause a ‘yes-yes’ or ‘no-no’ head tremor |
Other features | Often with slowness and stiffness | Usually, no other movement symptoms |
Progression | Gradually spreads with other Parkinson’s features | May slowly worsen, but movement stays otherwise normal |
Shaking or tremor is a common symptom with many possible causes, including:
- essential tremor – the most common cause of an action or postural tremor, unrelated to Parkinson’s disease. This tremor typically appears during movement or when holding a position
- dystonic tremor – usually characterised by a unilateral (one-sided) tremor that occurs with a specific movement, activity or posture
- physiological tremor – a normal, usually subtle tremor everyone has, which can become more noticeable with caffeine, stimulant use, anxiety, fatigue or as alcohol or certain drugs wear off
- low blood sugar
- medication side effects – including some antidepressants, asthma medications and antipsychotics
- overactive thyroid gland
- other neurological or brain conditions affecting movement-control pathways.
The pattern of tremor, including when it occurs, which body parts are involved, and what makes it better or worse, can help distinguish these causes. New or worsening shaking should be properly assessed rather than assumed to be Parkinson’s disease.
When to consider specialist review
Speak with your neurologist or GP if a tremor:
- is new, worsening or spreading to other body parts
- is accompanied by slowness, stiffness or balance changes that might suggest Parkinson’s disease
- behaves like essential tremor and is significantly affecting daily activities.
When to seek urgent help
Seek urgent medical attention for a sudden onset of:
- confusion (which may suggest a stroke)
- facial drooping
- severe shaking
- slurred speech
- tremor accompanied by weakness
- tremor alongside a rapid, unexplained decline in movement or alertness.
These symptoms require prompt assessment rather than a routine review.