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Tremors
Basics
OVERVIEW
Repetitive, rhythmic, oscillatory (swinging back and forth), involuntary movements of all or part of the body
The spine is composed of multiple bones with disks (intervertebral disks) located in between adjacent bones (vertebrae); the disks act as shock absorbers and allow movement of the spine; the vertebrae are named according to their location—cervical vertebrae are located in the neck and are numbered as cervical vertebrae one through seven or C1–C7; thoracic vertebrae are located from the area of the shoulders to the end of the ribs and are numbered as thoracic vertebrae one through thirteen or T1–T13; lumbar vertebrae start at the end of the ribs and continue to the pelvis and are numbered as lumbar vertebrae one through seven or L1–L7; the remaining vertebrae are the sacral and coccygeal (tail) vertebrae
Signalment/Description of Pet
Species
Dogs
Cats
Breed Predilections
Generalized tremor syndrome—small- to medium-breed dogs (less than 15 kg or 33 pounds)
Decreased amounts or absence of myelin, the protective covering of many nerve fibers (condition known as “hypomyelination”)—chow chows, English springer spaniels, Samoyeds, Weimaraners, and Dalmatians
Brief head tremor of unknown cause (so-called “idiopathic transient head tremor”)—Doberman pinschers, English bulldogs, and Labrador retrievers
Mean Age and Range
Age depends on cause
Generalized tremor syndrome—usually young adult dogs (less than 5 years of age)
Decreased amounts or absence of myelin, the protective covering of many nerve fibers (hypomyelination)—6–8 weeks of age
Signs/Observed Changes in the Pet
Localized or generalized tremors
Localized tremors—most often involve the head or the rear legs
Causes
Head Tremors
Abnormality of part of the brain, the cerebellum—degenerative; congenital (present at birth); inflammatory; immune-mediated; toxic causes
Unknown cause (so-called “idiopathic disease”)—Doberman pinschers and English bulldogs are more likely to develop head tremors of unknown cause than other breeds
Genetic
Inflammatory—inflammation of the brain (known as “encephalitis”)
Trauma
Drug administration—doxorubicin (a chemotherapy drug); diphenhydramine (an antihistamine); metoclopramide (medication used to control nausea and vomiting)
Rear Leg Tremors
May be a sign of weakness or pain in the lumbosacral area of the spine
Metabolic—kidney failure; inadequate production of parathyroid hormone, leading to abnormalities in blood calcium and phosphorus levels (condition known as “hypoparathyroidism”); decreased levels of glucose (sugar) in the blood (known as “hypoglycemia”)
Compressive lesions of the spine or nerve roots—narrowing of the spinal canal in the lumbosacral spine (known as “lumbosacral stenosis”); pressure to or damage of the nerves within the spinal canal in the area of the junction between the lumbar and sacral vertebrae—at this level of the spine, spinal nerves are located in the spinal canal (rather than spinal cord), these spinal nerves within the spinal canal are known as the “cauda equina” (condition known as the “cauda equina syndrome”); spinal cord tumor; bacterial or fungal infection of the intervertebral disks and adjacent bone of the spine (vertebral bodies; condition known as “diskospondylitis”)
Disorder involving the nerves to the rear legs (known as a “peripheral neuropathy”); neuromuscular junction abnormality; disorder involving the muscles of the rear legs (known as a “myopathy”)
Poor blood flow to the muscles of the rear legs—right-to-left shunting of blood flow through a birth defect, known as a “patent ductus arteriosus”; other diseases of the heart and lungs
Unknown cause (so-called “idiopathic disease”)—rear leg tremors in older dogs (so-called “senile tremor”)
Generalized Tremors
Decreased amounts or absence of myelin, the protective covering of many nerve fibers (hypomyelination)
Poisons—organophosphates (type of insecticide); hexachlorophene (an antiseptic product); bromethalin (product used to kill rodents); topical product for killing parasites that contains moxidectin and imidacloprid
Degenerative nervous system disease—inherited metabolic diseases in which harmful levels of materials accumulate in the body's cells and tissues (known as “storage diseases”); a disorder characterized by progressive deterioration of nervous tissue, causing the formation of numerous tiny holes in the brain (known as “spongiform encephalopathy”)
Generalized tremors of unknown cause (so-called “idiopathic generalized tremor syndrome”)—generalized body tremors seen in young, predominantly small-breed dogs, initially described in white dogs (such as Maltese and West Highland white terriers, leading to the name, “white shaker dog syndrome”)
Risk Factors
Any inflammation of the brain (encephalitis) or degenerative nervous system disease—inherited metabolic diseases in which harmful levels of materials accumulate in the body's cells and tissues (storage disease); a disorder characterized by progressive deterioration of nervous tissue, causing the formation of numerous tiny holes in the brain (spongiform encephalopathy)
Treatment with doxorubicin (a chemotherapy drug); diphenhydramine (an antihistamine); metoclopramide (medication used to control nausea and vomiting)
Treatment
Health Care
Treat the underlying primary disease
Outpatient, unless surgical treatment is indicated (such as lumbosacral disease that requires decompression and stabilization)
Avoid excitement and exercise—may worsen many tremors
Generalized tremor of primary brain origin—pet may lose weight; monitor weight and modify oral intake accordingly
Drug-induced tremors—consider an alternate drug
Suspected poisoning—remove pet from further exposure; contact your pet's veterinarian immediately; consult with a poison control center for possible antidote
Surgery
Surgery may be indicated for some causes of tremor (such as diseases involving the lumbosacral spine)
Medications
Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
Usually do not respond to muscle relaxants or drugs to control seizures (such as phenobarbital or diazepam)
Steroids—to decrease the immune response (known as giving an “immunosuppressive dose” of steroids) to treat generalized tremor syndrome
Antibiotics—for bacterial infection of the intervertebral disks and adjacent bone of the spine (vertebral bodies; condition is diskospondylitis); chosen on the basis of bacterial culture and sensitivity testing results of samples from the spinal lesion, blood, or urine
Diseases of part of the brain, the cerebellum—depends on the diagnosis
Gabapentin may be helpful in treatment of some tremors
Follow-Up Care
Patient Monitoring
Monitor the primary disease
Steroids for generalized tremor syndrome—monitor weekly initially to assess response to treatment
Preventions and Avoidance
Avoid excitement and exercise—may worsen many tremors
Expected Course and Prognosis
Most causes of tremors in adult dogs are treatable
Degenerative nervous system diseases (such as inherited metabolic diseases in which harmful levels of materials accumulate in the body's cells and tissues [storage disease]; a disorder characterized by progressive deterioration of nervous tissue, causing the formation of numerous tiny holes in the brain [“spongiform encephalopathy”])—no treatment available
Decreased amounts or absence of myelin, the protective covering of many nerve fibers (hypomyelination)—generally not treatable; some breeds (such as the chow chow) improve with maturity
Head tremor of unknown cause (idiopathic head tremor)—no effective treatment available; benign tremor that occurs sporadically; has few health consequences
Key Points
Repetitive, rhythmic, oscillatory (swinging back and forth), involuntary movements of all or part of the body
Localized tremors—most often involve the head or the rear legs
Most causes of tremors in adult dogs are treatable
Basics
