Q: Over the past year or so, I have noticed that my hands are shaking more than normal. My doctor says it’s my age and is nothing to worry about, but I am concerned that it could be the first sign of Parkinson’s disease.
A: At least a million people in the UK are troubled by tremor – the ‘shakes’ – and although Parkinson’s disease is often the first thing that springs to mind, there is another more common and less worrying cause – essential tremor (ET).
ET typically causes trembling of the hands or shaking of the head, but the legs, trunk and voice, can all be affected too. Tremors of the head (normally of the side-to-side ‘no-no’ type) are the next most common complaint, followed by the tongue and a tremulous voice. The shaking tends to be worse in certain postures, and is aggravated by stress, anger, fatigue and hunger, but relieved by rest and drinking alcohol.
Although often confused with much rarer Parkinson’s disease, there are some distinguishing factors. In Parkinson’s the tremor is normally associated with stiffness, slow shuffling gait and loss of facial expression, and it tends to be slower and more noticeable at rest. And while tremor of the head is a predominant symptom in a third of people with ET, it is unusual in Parkinson’s.
It is still not known why people develop essential tremor, but it is much more common in older people and it often runs in families. Not everyone needs treatment. Confirming the diagnosis – which generally does not require any special tests – and advice to avoid caffeine, which often aggravates the shakes, may be all that is required in milder cases.
For those more troubled by their tremor, there are two commonly used prescription-only drugs – the beta-blocker propranolol and the epilepsy medication primidone – that provide some improvement in up to three-quarters of cases.
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