When the hands are shaking

Proven content

– When I carry my coffee to the table in a bar, I am stressed that I will spill it. People look at me as an alcoholic or a drug addict, and then my hands tremble even more – says Marek, suffering from spontaneous hand tremors.

The causes of hand tremors are very diverse. It can be caused by a serious illness or strong emotions, and sometimes simply by physical fatigue.

The disease of trembling hands

If the trembling of the hands is not the result of physical fatigue, e.g. after intensive training in the gym, or emotional tension, it may be the result of the so-called spontaneous hand tremor diseases. We don’t know exactly what causes it. Despite its gentle nature, it can be very stressful. For those suffering from it, the problem is to make precise movements, e.g. when using cutlery, writing or shaving, and for some patients, even keeping a glass without spilling liquid can be quite a challenge. Marek says that when he was to fly by plane, his hand luggage was checked during check-in. My hands were shaking as I was taking my things out of my bag, as if I was carrying two kilos of amphetamines. It was really stressful, she recalls.

The patient’s hands tremble when performing an activity, but they do not tremble when at rest. The disease can begin at any age, but an increased incidence has been observed in the second and sixth decades of life. Its mild forms do not require the administration of drugs. You have to avoid caffeine, get a good night’s sleep and fight stress. However, if basic life activities – eating, drinking and shaving – are a problem, medication may be considered. In the fight against this ailment, cardiological drugs, antiepileptic drugs, sedatives and even botulinum toxin injections are used.

It could be Parkinson’s disease

Hand tremors can also be a symptom of Parkinson’s disease. Although it mainly affects the elderly, it can also affect younger people. – My youngest patient was 21 years old – says prof. Andrzej Bogócki, head of the Department of Extrapyramidal System Diseases, Medical University of Lodz. In Parkinson’s patients, the cells of the substantia nigra are atrophied, the function of which is the coordination of involuntary movements and rapid movements, and the decrease in dopamine concentration to approx. 20% of the normal value. is responsible for motor drive, coordination and muscle tension. The most common symptoms of the disease are stiffness and a characteristic stooped figure as well as trembling of the hands while at rest. When the patient is not doing anything, his hands tremble or make circular movements with his thumb and index finger.

Parkinson’s disease is incurable. Drugs only reduce its symptoms. The initial stage, characterized by relatively mild symptoms and high drug efficacy, takes about 5 years. In the advanced stage, patients’ quality of life deteriorates dramatically as the effectiveness of drugs decreases. – The patient is in a state of shutdown for many hours during the day, sits stiff and unable to move, my hands are shaking. Then it falls into a state of onset, in which involuntary movements, often very violent, are revealed. It is like a mad dance with undulating movements of the hands. This picture of Parkinson’s disease is less known because the patient in this stage does not leave his apartment and is seen only by family members and caregivers – explains Prof. Andrzej Bogócki.

Parkinson’s treatment

– There is no treatment to inhibit the progression of the disease. However, we have symptomatic treatment, which, especially in its first years, enables the patient to maintain physical fitness and function independently in everyday life, says Prof. Grzegorz Opala from the Polish Neurological Society. In the advanced stage of the disease, a significant improvement in mobility and quality of life can be achieved by using deep brain stimulation or by administering drugs in a way that ensures their constant level in the nervous system. Deep brain stimulation consists in placing electrodes in it, which are connected by a cable to a stimulator placed under the skin on the chest. The batteries in the currently used pacemakers last for several years. The procedure is fully reimbursed by the National Health Fund. However, it cannot be used in all patients due to the presence of contraindications. These include, among others depression, mild dementia and previous stroke. For these patients, pharmacological methods of continuous administration of drugs through a special pump into a catheter placed in the patient’s intestine or subcutaneous infusions, also with the use of a special pump, are an opportunity. Unfortunately, none of these forms of pharmacological treatment is reimbursed in Poland, and the annual cost ranges from PLN 30 to PLN 50. zloty. – Depriving patients with advanced Parkinson’s disease of appropriate and effective treatment dramatically worsens their quality of life, leads to social exclusion and progressive disability, and worsens further prognosis – says Prof. Opal.

Parkinson’s disease diagnosis

There is no single diagnostic test that can confirm Parkinson’s disease. It is diagnosed on the basis of a number of characteristic symptoms. It is assumed that a neurologist with experience in the diagnosis and treatment of this type of disease correctly diagnoses Parkinson’s disease in 80-90% of cases. Diagnostic errors most often result from difficulties in interpreting symptoms at an early stage of the disease and in atypical cases. Clinical studies have shown that the diagnoses of essential tremor are common mistakes and mistakes. The average time from the onset of clinical symptoms to the correct diagnosis is 1,5 years. However, essential tremor is very different from Parkinson’s disease. In the case of the first disease, tremors appear when we want to use our hands. In contrast, Parkinson’s disease is characterized by resting tremor, that is, the hands tremble when they are lying freely along the body or on the thighs. When the sick person reaches for a glass, for example, the tremors decrease or disappear. In addition, Parkinson’s disease has a number of other symptoms, unlike essential tremor.

It could be multiple sclerosis (MS)

In younger people, multiple sclerosis (MS) must also be considered among the causes of hand tremor. The result of this disease is tremors, but also difficulty speaking, difficulty swallowing. In multiple sclerosis patients, tremors are greatest when they complete their intended movement, for example, when trying to touch a finger to their nose. Hand tremors can also be caused by damage to the cerebellum, medication and drug side effects, hyperthyroidism, liver failure, heavy metal poisoning, fever, hypoglycemia (low blood sugar), or peripheral neuropathy (damage to the nerves in the arms and legs). It can also be the result of a stroke, cancer, or alcoholism.

Text: Halina Pilonis

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