Tremor and Parkinson’s

Tremor and Parkinson’s

Tremor is one of the three symptoms most often associated with Parkinson’s (alongside rigidity and slowness of movement).¹ But every person with Parkinson’s has a different set of symptoms, so not everyone with the condition will have or develop a tremor.² Tremor can also be a symptom of conditions other than Parkinson’s.³

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.

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.³
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.⁴ 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’.⁴

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.¹
For some people, a tremor can be the first symptom of Parkinson’s.
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.⁴

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.⁵
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.⁶
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 5.

Will my tremor get worse as my Parkinson’s progresses?

Medication may help control this symptom,⁷ but Parkinson’s tremor does usually get worse over time.⁴ 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.⁸

After several years, the tremor can spread to affect the other side of the body.⁴
In severe cases, the tremor can also spread to involve other parts of the body, including the lips or jaw.⁴ Some people also experience an ‘internal tremor’.⁹ 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.

“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

Can anything else make my tremor worse?

A tremor can sometimes appear after a period of stress.¹⁰
If you have Parkinson’s, you might find your tremor gets worse in stressful situations.¹¹ However, this is temporary and the tremor should settle when you’ve calmed down.
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.¹⁰
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.
“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

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 affected by 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.⁷

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,¹¹ 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.¹³

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.¹³

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
[e-mail]
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

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 [e-mail]. 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.
Thank you to everyone who contributed to and 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
[e-mail]
parkinsons.org.uk/publications
Parkinson’s UK makes every effort to make sure that its services provide up-to-date, unbiased and accurate facts. We hope that these will add to any professional advice you have had 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.

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)

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*Calls are free from UK landlines and most

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Last updated April 2013. Next update available April 2015.

© 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).

References

1 National Collaborating Centre for Chronic Conditions (2006) ‘Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care’ Royal College of Physicians, London; 3

2 National Collaborating Centre for Chronic Conditions (2006) ‘Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care’ Royal College of Physicians, London; 29

3 National Collaborating Centre for Chronic Conditions (2006) ‘Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care’ Royal College of Physicians, London; 30

4 PRODIGY (2009) Parkinson's disease – Management. How do I differentiate Parkinson's disease from essential tremor? http://prodigy.clarity.co.uk/parkinsons_disease/management/scenario_diagnosis/differential_diagnosis/differentiating_parkinsons_disease_from_essential_tremor [Accessed: March 2013]

5 National Collaborating Centre for Chronic Conditions (2006) ‘Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care’ Royal College of Physicians, London; 36
6 Jankovic J (2008) ‘Parkinson's disease: clinical features and diagnosis’ J Neurol Neurosurg Psychiatry; 79:368-376

7 National Collaborating Centre for Chronic Conditions (2006) ‘Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care’ Royal College of Physicians, London; 59-100

8 Dickson JM, Grünewald RA (2004) ‘Somatic symptom progression in idiopathic Parkinson's disease’ Parkinsonism Relat Disord;10(8):487-92

9 Bayulkem K and Lopez G (2011) ‘Clinical approach to nonmotor sensory fluctuations in Parkinson's disease’ J Neurol Sci; 310(1-2):82-5

10 Crawford P, Zimmerman EE (2011) ‘Differentiation and diagnosis of tremor’ Am Fam Physician;83(6):697-702
11 Raethjen J et al (2008) ‘Provocation of Parkinsonian tremor’ Mov Disord. 15;23(7):1019-23
12 National Collaborating Centre for Chronic Conditions (2006) ‘Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care’ Royal College of Physicians, London; 101
13 NICE Guidelines (2011) ‘IP019 Deep brain stimulation for Parkinson's disease: guidance 26 November 2003’ www.nice.org.uk/IPG019 [Accessed: March 2013]

Tremor and Parkinson’s (2013)
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 [e-mail]. Thanks! Please tick:
 I have Parkinson’s. When were you diagnosed? ……………………………………………………...
 I’m family/a friend/a carer of someone with Parkinson’s
 I’m a professional working with people with Parkinson’s
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