I’ve noticed a tremor in my right hand. It’s not too severe, and it come and goes. How worried should I be?
Dr Philippa Kaye answers: Stop and hold your hands out in front of you. Are they completely steady or is there a slight tremor?
What about when you let your hands rest in your lap?
How patients answer these two questions – which should take no longer than 30 seconds – can give some indication of whether the issue requires an urgent trip to the GP.
Let me explain. More than one in 20 adults over the age of 65 experience the involuntary shaking movement – making it the most common movement disorder in adults.
Some patients only experience a mild tremor that is easy to ignore. But others have the symptom so severely that tasks like drinking a cup of tea become very difficult.
There are many potential causes of a tremor and most of them are not serious.
Certain medicines can trigger a tremor. These include certain asthma inhalers, antidepressants, and steroids.
Parkinson’s is a degenerative brain disease that affects physical movement and brain function
An overactive thyroid – known as hyperthyroidism – can also cause a tremor. This occurs when the butterfly-shaped organ in the neck produces too many hormones. Patients would normally also experience weight loss, and heart palpitations.
Low blood sugar can also lead to the issue. However, this normally would only happen to patients with the blood sugar condition diabetes or those who have not eaten for a long time.
In rare cases, a tremor may be a symptom of Parkinson’s disease – the degenerative brain condition that affects physical movement and brain function.
However, there are telltale signs when a tremor is linked to Parkinson’s. Typically, the tremor starts on one side of the body and only occurs when the muscles are relaxed.
So, returning to those two questions I posed, Parkinson’s patients would only expect to experience a tremor, say, when their hand is resting in their lap, and not when they are holding their hands up.
Here, the tremor is often prescribed as ‘pill rolling’ because it looks as though the patient is rolling a tablet between finger and thumb.
For actor Michael J. Fox, who was diagnosed with Parkinson’s in 1991, the first sign was a twitch in his little finger.
Moreover, Parkinson’s usually leads to other symptoms such as muscle stiffness, slow movement and balance issues.
Anyone who experiences these symptoms should see their GP.
However, patients whose only symptom is a tremor that happens while trying to do something – like holding hands out or writing – are much more likely to have a condition called essential tremor.
For actor Michael J. Fox, who was diagnosed with Parkinson’s in 1991, the first sign of the disease was a twitch in his little finger
An essential tremor is a harmless – but incurable – problem that often affects older patients. Its cause is unknown but it often runs in families.
While there are no effective medical treatments, there are lifestyle changes that can ease the problem.
There is good evidence to show that cutting back on caffeine – such as tea, coffee and energy drinks – can help, as these drinks make the problem worse.
Likewise, too much alcohol can also worsen tremors and many people experience the problem when hungover.
A lack of sleep is also linked to severe tremors. The NHS advises that most people need around seven to eight hours of sleep a night.
Stress can impact the condition. Anyone who believes stress is to blame for their tremors should consider talking therapy.
GP, author and broadcaster Dr Philippa Kaye
In severe cases, GPs may prescribe daily tablets called beta–blockers. These drugs, such as propranolol, dampen the effects of adrenaline – a hormone that increases heart rate and stimulates the muscles.
By reducing the effect of adrenaline, beta–blockers can help reduce tremors.
If these fail, then GPs might consider anti–seizure medicines that lower excessive electrical activity in the brain linked to tremors.
However, many patients prefer to avoid medication and, instead, adapt their behaviour.
Older patients with essential tremor are often advised to use weighted glasses or cups for drinking, to reduce spillage, and to avoid filling cups to the brim.
Likewise, heavier cutlery may also make eating easier.
Interestingly, people who struggle with actions such as getting dressed or brushing teeth due to tremors sometimes find that tucking the elbows into their sides can reduce the problem.
- Write to Dr Philippa Kaye at Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: health@mailonsunday.co.uk – include contact details. Dr Kaye cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.
