Parkinson`s and Tremor - Parkinson`s New Zealand

FACT SHEET
Parkinson’s and Tremor
A tremor is an involuntary, rhythmical movement that affects one or more parts of the body. It may affect the hands,
head, legs, body and/or voice. Tremor is the most common visible sign of Parkinson’s. It is also one of the symptoms
most often associated with Parkinson’s.
DOES EVERYONE WITH PARKINSON’S
DEVELOP A TREMOR?
WILL ANYTHING MAKE MY TREMOR WORSE?
No. Approximately 70% of people with Parkinson’s will develop a
tremor, and not all tremors are a symptom of Parkinson’s.
WHAT CAUSES TREMOR IN PARKINSON’S?
Parkinson’s is caused by the degeneration of a group of nerves in
an area of the brain called the substantia nigra, which is located
in the base of the brain. These nerves produce the chemical
dopamine which is a neurotransmitter – a chemical that is
released by the nerve cells to send messages to other nerve cells.
This degeneration of the dopamine system produces a loss of
inhibition of certain brain structures. This causes parts of the
nervous system to fire rhythmically causing a tremor.
Emotions such as stress, anxiety, anger or fear can cause
tremor in all people and can worsen tremor in a person with
Parkinson’s. However, this is temporary and will settle down as
the heightened emotion subsides.
Tremor can also be caused or worsened by some medications
including some used to treat mental health conditions, antinausea and anti-dizziness medications. There are also some antiasthma drugs, and the anti-epileptic sodium valproate which can
heighten tremor. It is always good to discuss new medications
with your doctor to see if that particular medicine can cause
or worsen tremor. Never stop taking medication without first
consulting your doctor.
IS THERE ANY TREATMENT FOR TREMOR?
ARE ALL TREMORS THE SAME?
There are two main types of tremor that affect people with
Parkinson’s.
Although there is no cure for tremor, there are ways it can
be managed.
7
•฀ Resting฀tremor฀–฀this฀occurs฀when฀your฀body฀is฀relaxed฀and฀
the affected part is not doing anything. Often this tremor
has some distinct characteristics, commonly called ‘pill
rolling’ as people seem to be rolling a small sphere between
their thumb and index finger.
•฀ Action฀tremor฀–฀this฀tremor฀happens฀when฀you฀are฀making฀
a movement, like drinking from a cup or holding something.
This tremor is usually more intrusive as it interrupts
intended function.
People with Parkinson’s may be affected by both of these
tremors though resting tremor is more common.
Self help
As anxiety or stress can make tremor worse, it is important to
find ways to relax. Exercise can also help to improve your sense
of wellbeing. Activities like yoga and complementary therapies
like acupunture, reflexology, music and art therapy may also help
you relax.
Some people with a mild hand tremor find that squeezing or
rolling a ball, pen or similar object can help supress the tremor.
Medication
A tremor is sometimes the first symptom of Parkinson’s. Usually
it starts in the fingers of one hand and in time can spread up the
arm and even extend to other parts of the body as the condition
progresses. Occasionally, Parkinson’s tremor might start
elsewhere, like the foot, and then spread from the leg to the arm
on the same side.
Tremor can sometimes be suppressed by medication. Levodopa
(Madopar, Sinemet, or Sindopa) can reduce or stop tremor quite
effectively in some people. However, not everyone’s tremor
responds to levodopa even if in the same person the other
‘cardinal features’ like rigidity and slowness of movement,
respond well to the drug. Current thinking is that this may
be because tremor, unlike other symptoms of Parkinson’s like
rigidity and slowness of movement, is not a direct effect of a
lack of dopamine.
In some cases, tremor can spread to involve other parts of the
body including the lips, tongue, jaw or trunk of the body. Tremor
of the head is very uncommon. Some people with Parkinson’s
experience an ‘internal tremor’ where there is a feeling of a
tremor within the body but there are no visible signs of this to
other people.
Dopamine agonist medications like ropinirole, lisuride and
pramipexole also have anti-tremor effects when used alone or
in combination with levodopa. People taking these drugs need to
be aware that sometimes a side effect of these drugs is impulse
control disorder. Please refer to our booklet The Drug Treatment
of Parkinson’s for more information.
HOW DOES TREMOR AFFECT PEOPLE
WITH PARKINSON’S?
MARCH 2014
FACT SHEET – CONTINUED FROM PREVIOUS PAGE
There are also some anti-cholinergic medications such as
orphenadrine and benztropine (used to treat motion sickness
and REM sleep disorder) that can have a role to play in tremor
management, for those who are unable to take dopaminergic
drugs. These medications can cause or aggravate memory
problems in some people.
Beta-blocking drugs can also reduce tremor is some cases.
People may use them in small doses to control their tremor
where they feel it may be worsened by a situation where they
may be nervous (e.g. before a big meeting or social occasion).
You will need to consult your doctor to see if this is a suitable
treatment for you.
As with all medications and other treatments, advice should
always be sought from your doctor or specialist to ensure that
you are taking the right medication for you. No two people with
Parkinson’s are the same and no two treatments will be exactly
the same.
Deep brain stimulation
Deep brain stimulation involves implanting small electrodes
within the brain. A implanted pulse generator is inserted
surgically under the skin on the person’s chest. This then passes
small electric currents through the electrodes in the brain.
This surgery is not suitable for everybody but for those who
have it, there is usually improvement in their tremors.
Essential Tremor
People often confuse Parkinson’s with Essential Tremor.
In some cases, people who are diagnosed with Essential
Tremor are later found to actually have Parkinson’s, and
vice-versa.
8
Essential Tremor is a separate condition and far more
common that Parkinson’s. Essential Tremor primarily affects
the hands, and often the head and rarely the feet. Voice,
tongue, legs and trunk may be affected too. The head tremor
may be seen as a “yes-yes” or “no-no” motion.
Essential Tremor is an action tremor that occurs when the
affected body part is moving.
Essential Tremor can happen at any age but is most common
after age 40. There is a family history of Essential Tremor in
about 50% of those affected. In familial Essential Tremor
children of a parent with Essential Tremor have a 50%
chance of inheriting the condition.
Sources: Parkinson’s UK, EPDA, The Parkinson’s Disease Foundation
The Richter Series
Wellington artist Pippa Carvell, was diagnosed with Parkinson’s
when she was 25. This work is part of Pippa’s “Richter Series” of
line drawings, which records, like a seismograph, her Parkinson’s
symptoms of tremor and freezing. The series is also a permanent
record of Pippa’s determination to make choices and decisions
and take back some control over her life.
Pippa starts each drawing by grasping an Indian ink pen in her
right hand. She then uses her left hand to pull the right one
across the page. The process is repeated, line after line. Freezes
and pauses are recorded as nodes of bleeding ink. Massive
concentration is required and sometimes the whole exercise
becomes transcendent and meditative. The work reflects her
emotions. Tremors recorded in a line may become amplified in
succeeding ones if stress levels are high. If Pippa’s medication
is working its
magic and she
relaxes enough to
lose herself in her
work, the seismic
landscape she
creates gradually
flattens out.
In 2011, Pippa
exhibited her
work in London.
“If Pippa’s medication is wrking its magic and she relaxes enough to lose herself
in her wrk, he seismic landscape she creates gradualy lattens out.”
THE PARKINSONIAN
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