From the Guidelines
Tremors can be classified into several types, including rest tremors, action tremors, essential tremor, intention tremors, physiologic tremors, and task-specific tremors, each with distinct characteristics and treatment options. The following table differentiates between types of tremor, examples, and treatment:
| Type of Tremor | Characteristics | Examples | Treatment |
|---|---|---|---|
| Rest Tremor | Occurs when muscles are relaxed | Parkinson's disease | Dopaminergic medications like levodopa-carbidopa (starting at 25/100mg three times daily) or dopamine agonists such as pramipexole (0.125mg three times daily, gradually increased) [1] |
| Action Tremor | Includes postural tremors and kinetic tremors | Essential tremor, multiple sclerosis | Propranolol (starting at 20mg twice daily, up to 240mg daily) or primidone (starting at 12.5-25mg at bedtime, gradually increased to 250mg daily) for essential tremor; clonazepam (0.5mg twice daily) or topiramate (25mg daily, gradually increased) for intention tremors [1] |
| Essential Tremor | Most common postural tremor, affecting hands, head, or voice | Essential tremor | Propranolol (starting at 20mg twice daily, up to 240mg daily) or primidone (starting at 12.5-25mg at bedtime, gradually increased to 250mg daily) [1] |
| Intention Tremor | Worsens as the limb approaches a target | Multiple sclerosis, cerebellar lesions | Clonazepam (0.5mg twice daily) or topiramate (25mg daily, gradually increased) [1] |
| Physiologic Tremor | Normal, but can be enhanced by anxiety, caffeine, or medications | Normal individuals | Addressing underlying cause, stress reduction, avoiding tremor-inducing substances [1] |
| Task-Specific Tremor | Occurs during specific activities, like writing | Writer's cramp | Botulinum toxin injections (50-100 units every 3 months) [1] |
| Some key points to consider when treating tremors include: |
- Tailoring treatment to the specific tremor type, underlying cause, and severity 1
- Using non-pharmacological approaches, such as stress reduction, avoiding tremor-inducing substances, and physical therapy to improve coordination and strength 1
- Employing anxiety management and distraction techniques when undertaking a task can be helpful 1
- Video recording interventions can be useful to play back to the person to identify changes in symptoms and demonstrate changeability 1
- Serial casting for fixed functional dystonia has been associated with worsening symptoms and the onset of complex regional pain syndrome, and removable splints may have an overall positive effect in some cases, but benefits should be balanced against potential harm 1
From the FDA Drug Label
Table 4 lists treatment-emergent adverse reactions that occurred in at least 2% of patients with advanced Parkinson’s disease (with L-dopa) treated with ropinirole who participated in the double-blind, placebo-controlled trials and were numerically more common than the incidence for placebo-treated patients.
Table 4 (with L-dopa) (Events ≥2% of Patients Treated with Ropinirole and Numerically More Frequent than the Placebo Group) (n = 208) (%) (n = 120) (%) ... Tremor 6 3
The types of tremor are not explicitly differentiated in the provided drug label. However, based on the context, it can be inferred that the tremor mentioned is likely related to Parkinson's disease.
- Parkinson's disease is associated with a resting tremor, which is a tremor that occurs when the limb is at rest.
- The treatment for tremor in Parkinson's disease may include ropinirole, as mentioned in the drug label.
- Ropinirole is a dopamine agonist that can help alleviate symptoms of Parkinson's disease, including tremor.
- Other types of tremor, such as essential tremor or action tremor, are not explicitly mentioned in the drug label.
- The treatment for other types of tremor may differ from that of Parkinson's disease-related tremor. 2
From the Research
Types of Tremor
- Essential tremor: characterized by an action and postural tremor, most often affecting the arms, but can also affect other body parts 3, 4, 5
- Parkinsonian tremor: occurs mainly at rest, and is a symptom of Parkinson's disease 6
- Cerebellar tremor: caused by damage to the cerebellum, and can affect the arms, legs, or trunk 6
- Dystonic tremor: a symptom of dystonia, characterized by involuntary muscle contractions 6, 7
- Orthostatic tremor: occurs when standing, and is characterized by a rapid tremor of the legs and trunk 6
- Physiologic tremor: a normal tremor that occurs in healthy individuals, and is usually not noticeable 6
- Psychogenic tremor: a tremor that is caused by psychological factors, and can be characterized by a variable tremor frequency and amplitude 6, 7
Examples of Tremor
- Hand tremor: can be caused by essential tremor, Parkinson's disease, or other conditions 3, 6
- Head tremor: can be caused by essential tremor, dystonia, or other conditions 7
- Vocal cord tremor: can be caused by essential tremor, and can affect the voice 5
- Leg tremor: can be caused by orthostatic tremor, Parkinson's disease, or other conditions 6
Treatment of Tremor
- Medications: propranolol, primidone, topiramate, and botulinum toxin are commonly used to treat tremor 3, 6, 4, 7, 5
- Deep brain stimulation: a surgical procedure that can be used to treat severe tremor, particularly essential tremor and Parkinson's disease 3, 6, 4, 5
- Thalamotomy: a surgical procedure that can be used to treat severe tremor, particularly essential tremor 4, 7
- Focused ultrasound thalamotomy: a newer surgical alternative that can be used to treat severe tremor, particularly essential tremor 3, 5
- Occupational therapy, speech therapy, and psychotherapy: can be used to help patients with tremor to adapt to their condition and improve their quality of life 3