Dr Samuel Bolitho


Tremors are rhythmic, involuntary shaking or oscillations of a part of the body, typically involving the hands, arms, head, or vocal cords. Tremors can occur as a result of various underlying causes, and they can be categorised into different types based on their characteristics.

Causes of Tremors

The exact cause of essential tremor is unknown. Studies show that essential tremor is accompanied by a mild degeneration of the cerebellum, which is the part of your brain that controls movement coordination. Common causes of tremors include:

  • Essential Tremor: Essential tremor is the most common type of tremor. It is often hereditary and typically affects the hands, but it can also involve the head, voice, or other body parts. The exact cause is unknown, but it may involve abnormal brain activity.
  • Parkinson’s Disease: Parkinson’s disease is characterised by resting tremors, which usually begin in one hand and involve a “pill-rolling” motion. It is caused by a lack of dopamine in the brain due to the loss of dopamine-producing cells.
  • Physiological Tremor: This is a normal tremor that everyone experiences to some degree. It can be triggered by factors such as stress, fatigue, caffeine, or low blood sugar.
  • Dystonic Tremor: Dystonia, a movement disorder characterised by muscle contractions, can lead to tremors in affected body parts.
  • Cerebellar Tremor: Damage or dysfunction of the cerebellum, a part of the brain that controls coordination, can cause tremors. This type of tremor is often seen in conditions like multiple sclerosis.
  • Psychogenic Tremor: These tremors are thought to have a psychological origin and may be related to stress or other emotional factors.
  • Drug-Induced Tremor: Certain medications, such as stimulants, corticosteroids, and some antidepressants, can induce tremors as a side effect.

Symptoms of Tremors

Tremor symptoms can vary in frequency, amplitude (severity), and affected body part. Common symptoms include:

  • Rhythmic Shaking: Involuntary and rhythmic shaking of the affected body part/s.
  • Variability: Tremors can occur at rest (resting tremor) or during voluntary movements (action tremor).
  • Intensity: Tremors can range from mild to severe, sometimes making it difficult to perform fine motor tasks.
  • Location: Tremors most commonly affect the hands and fingers, but they can also involve the arms, head, vocal cords (resulting in a shaky voice), legs, or other body parts.
  • Worsening Factors: Certain triggers like stress, fatigue, or caffeine intake can exacerbate tremors.

Treatment Options for Tremors

The treatment of tremors depends on the underlying cause and the severity of symptoms. Here are various treatment options:
  • Beta-Blockers: Medications like propranolol and primidone are often prescribed for essential tremor and can help reduce tremor severity.
  • Anticonvulsants: Drugs like gabapentin and topiramate may be used to manage essential tremor.
  • Dopaminergic Medications: In the case of tremors associated with Parkinson’s disease, medications like levodopa may be prescribed to increase dopamine levels in the brain.
In some cases, particularly for focal dystonic tremors, Botox injections can help alleviate symptoms by relaxing affected muscles.
This involves surgically implanting electrodes into specific brain regions to modulate abnormal neural activity. It is often considered for essential tremor and Parkinson’s disease when medications are ineffective.
Therapy can help individuals with tremors develop strategies to manage daily tasks and improve motor control.
Reducing caffeine intake, managing stress, getting adequate sleep, and maintaining a healthy lifestyle can help minimise the impact of tremors.
In severe cases of essential tremor or Parkinson’s disease, surgical procedures like thalamotomy or MRI Guided Focused Ultrasound (MRgFUS) may be considered to target and disrupt the brain circuits responsible for tremors.

It’s important to note that the choice of treatment depends on the specific type of tremor and its underlying cause. Individualised treatment plans, often developed in consultation with neurologists or movement disorder specialists, can provide the best outcomes for managing tremors and improving quality of life. Additionally, ongoing research continues to explore new treatment options and improve existing therapies for tremor disorders.

If you have a tremor disorder and you are looking for options to improve your quality of life, please make an appointment with Dr Bolitho for an examination.

Get In Touch

Dr Samuel Bolitho is a Sydney Neurologist with sub-specialised training in movement disorders, essential tremor and Parkinson’s Disease. He brings a rare mx of medical, neurological and computational neuroscience expertise to his role, as well as a wealth of experience in biomedical engineering.