What is a tremor?
A tremor is a rhythmical, involuntary movement that affects a part of the body, for example the hand. Having
a tremor doesn’t necessarily mean you have Parkinson’s, but it is a common feature of the condition.
There are many different causes of tremor, but the most common type is an ‘essential tremor’ – a trembling
of the hands, head, legs, body and/or voice. It is most noticeable when you are moving.
An essential tremor can be difficult to tell apart from a Parkinson’s tremor. One difference is that essential
tremors don’t tend to affect you when your body is still – unlike a Parkinson’s tremor, which is more likely to
be a ‘resting tremor’.
What is a Parkinson’s tremor?
People with Parkinson’s don’t have enough of a chemical called dopamine. This is because some nerve cells in
their brain that produce dopamine have died. Without it, the symptoms of Parkinson’s appear, and these may
include a tremor.
For some people, a tremor can be the first symptom of Parkinson’s.
Tremor and Parkinson's
T
remor is one of the three symptoms most often associated with
Parkinson’s (alongside rigidity and slowness of movement). But
every person with Parkinson’s has a different set of symptoms, so not
everyone with the condition will have or develop a tremor. Tremor can
also be a symptom of conditions other than Parkinson’s.
This information sheet explains what having a tremor may mean for you
if you have Parkinson’s. It gives information about what can be done to
manage the symptom, and details of the healthcare professionals who
will be able to provide you with further advice and support.
Symptoms and lifestyle
2
A tremor caused by Parkinson’s can appear in two ways:
•
A
resting tremor might happen when your body is
relaxed, for example when you’re lying in bed.
•
An
action tremor can happen when you’re doing
something, like trying to hold a magazine or drink from
a cup.
The most typical tremor in Parkinson’s is called a ‘pill-
rolling’ rest tremor, as it looks like you are trying to roll
a pill between your thumb and index finger.
Usually, a specialist will be able to carry out a clinical assessment to see whether you have Parkinson’s tremor
or essential tremor. Sometimes, further tests, such as a brain scan called a DaTSCAN, may be helpful.
Speak to your GP if you’re worried about a tremor.
If I have Parkinson’s, will this symptom develop eventually?
It’s not possible to predict whether or not you will develop a tremor, as the condition varies from person to
person. Not everyone with Parkinson’s will have a tremor.
If you do develop a tremor, speak to your GP or specialist about the change in your symptoms. You can also
speak to your Parkinson’s nurse, if you have one. A Parkinson’s nurse is a qualified registered general nurse
with specialist experience, knowledge and skills in Parkinson’s. They play a vital role in the care of people with
Parkinson’s. You can read more about them on page 4.
Will my tremor get worse as my Parkinson’s progresses?
Medication may help control this symptom, but Parkinson’s tremor does usually get worse over time.
However, generally this is quite a slow process that occurs over several years. For many people with
Parkinson’s, their tremor isn’t constant and comes and goes. How it affects them can also change a lot.
Typically, Parkinson’s tremor starts in the fingers of one hand before ‘spreading’ to affect the rest of the arm.
The tremor can also spread to affect the foot, on the same side of the body. Occasionally, Parkinson’s tremor
starts elsewhere, for example in the foot, then it may spread up the leg and then into the arm.
After several years, the tremor can spread to affect the other side of the body.
In severe cases, the tremor can also spread to involve other parts of the body, including the lips or jaw. Some
people also experience an ‘internal tremor’. This is a feeling of tremor within the body, but it isn’t noticeable
to other people.
If your tremor does get worse, speak to your GP, specialist or Parkinson’s nurse about the change in your
symptoms.
Can anything else make my tremor worse?
A tremor can sometimes appear after a period of stress.
If you have Parkinson’s, you might find your tremor gets worse in stressful situations. However, this is temporary
and the tremor should settle when you’ve calmed down.
“
The slight tremor in my
right arm only becomes really
noticeable when I get stressed
– I’m more embarrassed about
revealing my anxiety than the
fact that I have Parkinson’s!
”
Roger, diagnosed in 2008
3
Parkinson’s tremor can be caused or made worse by
some drugs, such as tranquilisers, anti-sickness and
anti-dizziness medications. Some anti-asthma drugs,
antidepressants and anti-epileptic drugs could also make
your tremor more noticeable.
It is worth looking at the product information sheet that
comes with your medication to see if that particular
medicine can cause or worsen a tremor.
However, you might still need to take these medications, so if you have any concerns about the drugs you take,
speak to your GP, specialist or Parkinson’s nurse.
How can I manage my tremor?
There is no cure for a tremor, but there are ways to manage the symptom.
In the early stages of Parkinson’s, some people might be able to suppress their hand tremor by squeezing or
rolling a ball, pen or similar object.
Speak to your specialist or Parkinson’s nurse for advice. You may also find it useful to speak with other people
who are experiencing tremor, to find out what they do to help. See page 5 for information about our local
groups, online forum and peer support service.
Tips from others with Parkinson's
“There are a few things I do to help my tremor:
“I keep a small ball handy. I throw or even just transfer it from hand to hand. The tremor is considerably reduced
or even stops altogether for a few minutes.
“I squeeze a ball or other object like a pen or remote control in the palm of my hand that has a tremor.
“I keep myself busy by reading newspapers or completing a crossword. For a few minutes, the tremor continues,
but after a short while I settle down and there is little or no tremor.
“I pedal on my exercise bike and my tremor stops for at least a few minutes afterwards.”
Kris, diagnosed in 2004
“If tremor causes a problem with writing, a weighted armband from a sports shop (really meant for training
purposes) can help steady your hand. Just watch out for the side-effect of bigger muscles!”
Diana, diagnosed in 2004
For other tips for dealing with the symptoms of Parkinson’s from people affected by the condition, see our
booklet Tips and hints for people with Parkinson’s.
There are also other things you can do to help control your tremor:
Medication
Usually, your tremor can be effectively kept under control by some Parkinson’s medication, including levodopa
(sometimes known by brand names including Sinemet and Madopar) and some dopamine agonists.
“
I experience a lot of internal
tremor, but I’m fortunate that,
due to medication, my external
tremor only manifests itself
sometimes.
”
Caroline, diagnosed in 2003
4
You can find out more about Parkinson’s drugs in our booklet Drug treatments for Parkinson’s, or speak to
your specialist or Parkinson’s nurse about what may suit you.
There are other drugs that may also suppress your tremor – as everyone with Parkinson’s has a different
experience of the condition, it’s best to speak to your GP, specialist or Parkinson’s nurse about possible
medication options for you.
Stress relief
Anxiety or stress can make symptoms such as a tremor worse, so it’s really important to find ways to relax.
You may find exercise will help and may also improve your sense of wellbeing. Some people have also found
complementary therapies, such as aromatherapy, yoga, reflexology and music and art therapy, have helped
them to relax.
Find out more: see our booklet Complementary therapies and Parkinson’s.
Deep brain stimulation
Deep brain stimulation is a form of surgery that is used to control some of the symptoms of Parkinson’s –
including tremor. It involves passing small electrical currents through electrodes that
are permanently implanted in the brain.
Deep brain stimulation isn’t a suitable option for everyone and, like any surgery, there are some risks involved.
It is normally only considered as an option if your symptoms are severe and medical treatment is no longer
effective.
Find out more: see our booklet Surgery for Parkinson’s.
More information and support
The National Tremor Foundation
This charity provides information and support to people with any form of tremor.
01708 386 399
enquiries@tremor.co.uk
www.tremor.org.uk
Parkinson's nurses
Parkinson’s nurses provide expert advice and support to people with Parkinson’s and those who care for them.
They can also make contact with other health and social care professionals to make sure your needs are met.
The role of the Parkinson’s nurse can vary. Each will offer different services, aiming to meet local needs. Some
nurses are based in the community, whereas others are based in hospital settings.
Many Parkinson’s nurses are independent prescribers. This means they can prescribe and make adjustments
to medication, so someone with Parkinson’s doesn’t always need to see a specialist doctor for changes to or
queries about their Parkinson’s drugs.
Parkinson’s nurses may not be available in every area, but your GP or specialist can give you more details on
local services.
You can find out more at
parkinsons.org.uk/nurses
5
Information and support from Parkinson's UK
You can call our free confidential helpline for general support and information. Call
0808 800 0303 (calls are
free from UK landlines and most mobile networks) or email
hello@parkinsons.org.uk
We now run a peer support service if you’d like to talk on the phone with someone affected by Parkinson’s who
has faced similar issues to you. The service is free and confidential – ring the helpline and they will match you
with a peer support volunteer.
Our helpline can also put you in touch with one of our local information and support workers, who provide one-
to-one information and support to anyone affected by Parkinson’s. They can also provide links
to local groups and services.
Our website has information about your local support team and how to contact them at
parkinsons.org.
uk/localtoyou. You can find details of our local groups and your nearest meeting at parkinsons.org.uk/
localgroups. You can also visit parkinsons.org.uk/forum to speak with other people in a similar situation
on our online discussion forum.
6
Tremor and Parkinson's
If you have comments or suggestions about this information sheet, we’d love to hear from you. This will help
us ensure that we are providing as good a service as possible. We’d be very grateful if you could complete
this form and return it to
Resources and Diversity, Parkinson’s UK, 215 Vauxhall Bridge Road, London
SW1V 1EJ. Or you can email us at publications@parkinsons.org.uk. Thanks!
Please tick...
I have Parkinson’s. When were you diagnosed?
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If you would like to become a member of Parkinson’s UK, or are interested in joining our information review
group, please complete the details below and we’ll be in touch.
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Thank you
Thank you very much to everyone who contributed to or reviewed this information sheet:
Huw Morris, Professor of Neurology, Cardiff University and Royal Gwent Hospital
Alison Rose, Lead Movement Disorder Nurse Specialist, County Durham and Darlington
Foundation Trust
Thanks also to our information review group and other people affected by Parkinson’s who provided feedback.
How to order our resources
0845 121 2354
resources@parkinsons.org.uk
Download them from our website
at
parkinsons.org.uk/publications
We make every effort to make sure that our services provide up-to-date, unbiased and accurate
information. We hope that this will add to any professional advice you receive and will help you to make
any decisions you may face. Please do continue to talk to your health and social care team if you are
worried about any aspect of living with Parkinson’s.
References for this information sheet can be found in the Microsoft Word version at
parkinsons.org.uk/publications
We’re the Parkinson’s support and research charity. Help us find a cure and improve life for
everyone affected by Parkinson’s.
Can you help?
At Parkinson's UK, we are totally dependent on donations from individuals and organisations to fund the
work that we do. There are many ways that you can help us to support people with Parkinson's. If you would
like to get involved, please contact our Supporter Services team on
020 7932 1303 or visit our website
at
parkinsons.org.uk/support. Thank you.
Parkinson’s UK
Free* confidential helpline
0808 800 0303
Monday to Friday 9am–8pm, Saturday
10am–2pm. Interpreting available.
Text Relay
18001 0808 800 0303
(for textphone users only)
hello@parkinsons.org.uk
parkinsons.org.uk
*calls are free from UK landlines and most mobile networks.
© Parkinson’s UK, April 2013. Parkinson’s UK is the operating name of the Parkinson’s Disease Society of the
United Kingdom. A charity registered in England and Wales (258197) and in Scotland (SC037554).
Last updated April 2013. Next update available April 2015.
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