From the Guidelines
Intention tremors are rhythmic, oscillating movements that occur during voluntary, purposeful actions and worsen as the person approaches their target, such as when reaching for an object. These tremors result from damage to the cerebellum or its connecting pathways, often due to conditions like multiple sclerosis, stroke, traumatic brain injury, or cerebellar disease. Treatment typically begins with addressing the underlying cause when possible. Physical and occupational therapy are cornerstone treatments, focusing on improving coordination, strength, and developing compensatory strategies. Weighted devices like wrist weights or utensils can dampen tremors by adding resistance. Medications may help, although the provided evidence does not directly address intention tremors, it discusses the use of beta-blockers like propranolol for essential tremor 1, which might not be directly applicable but suggests the potential for similar treatments to be explored for intention tremors. However, based on the most recent and highest quality evidence available, which is not directly provided for intention tremors in the given studies, the approach would involve a comprehensive management plan including physical therapy, occupational therapy, and potentially medications like propranolol, though its use for intention tremors is not specified in the evidence provided. For severe, medication-resistant tremors, deep brain stimulation targeting the thalamus may be considered, with success rates of 70-90% in appropriate candidates, though this is based on general knowledge and not directly supported by the provided evidence. Lifestyle modifications like avoiding caffeine, getting adequate sleep, and managing stress are important complementary approaches, as these factors can exacerbate tremor severity. Given the lack of direct evidence on intention tremors in the provided studies, the treatment approach would prioritize physical and occupational therapy, with medication and other interventions considered on a case-by-case basis, always prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
From the Research
Definition of Intention Tremors
- Intention tremors are a type of tremor that occurs during voluntary movements, such as reaching or grasping for an object 2.
- They are characterized by an involuntary, rhythmic, oscillatory movement of a body part, typically the hands or arms 3.
- Intention tremors are often associated with cerebellar dysfunction or damage, and are considered a classic feature of cerebellar disease 2, 4.
Clinical Features of Intention Tremors
- Intention tremors typically occur during the final stages of a voluntary movement, such as when reaching for an object or trying to touch a target 2.
- They can be accompanied by other types of tremors, such as postural or rest tremors, as well as other motor features like gait ataxia or dystonia 5, 4.
- The frequency of intention tremors is typically in the range of 4-12 Hz, although this can vary depending on the individual and the specific condition causing the tremor 4.
Treatment of Intention Tremors
- Treatment for intention tremors often involves a combination of pharmacological and surgical therapies, depending on the underlying cause and severity of the tremor 6, 5.
- Medications such as propranolol, primidone, and gabapentin may be effective in reducing tremor severity, although their effectiveness can vary from person to person 5.
- Surgical options, such as deep brain stimulation (DBS) or thalamotomy, may be considered for patients with severe or medication-resistant tremors 6, 5.
- Botulinum toxin injections may also be used to treat intention tremors, particularly in cases where the tremor is localized to a specific area, such as the hand or head 5.