There are many causes of tremors. Parkinson’s Disease is one of the most common causes, and tremors are often the first sign of the disease. The tremor and other symptoms may initially appear only on one side of the body, or they may appear worse on one side than the other. A repetitive “pill-rolling" movement between the thumb and finger—named because it looks as though the person is rolling a pill between their fingers—is characteristic of a Parkinsonian tremor. [5] X Research source JOHN D. GAZEWOOD, MD, MSPH,D. ROXANNE RICHARDS, MD,KARL CLEBAK, MD, Parkinson’s An Update, The American Family Physician, 2013 Feb 15;87(4):267-273
These slowed movements are a very common early sign of Parkinson’s, and may show up at the onset of the disease in 80% of patients. Some people might have a hard time describing what they are feeling and use words like “weakness,” “tiredness,” or “incoordination” when talking about these symptoms. Look for distortions in voluntary movements. In addition to involuntary movements, those with Parkinson’s may experience disturbances in their voluntary movements beyond just slowness. Some of the treatments used for Parkinson’s disease may cause abnormal involuntary movements, or an increase in movement, referred to as dyskinesia. These distortions (dyskinesias) can be similar to a “tic” in appearance and worsen with psychological stress. Advanced dyskinesia is most often seen in patients who have been on the medication Levodopa for some time.
This symptom typically shows up in the later stages of the disease.
Rigidity can affect the whole body, and might you feel stiff or sore. Check for postural rigidity. Also referred to as “cog-wheeling,” this symptom presents as a hallmark, rigid motion when an examiner moves the arm of a patient through basic flexion and extension motions. The rigidity and resistance to movement is most obvious with passive movement of the wrists and elbow. Cog-wheeling may happen when the increased muscle tone related to rigidity is combined with a tremor.
The voice often becomes soft or whispery because the vocal muscles lack mobility.
These same symptoms often present along with difficulty swallowing food as well.
Rest your hand in your lap and look for tremor. Unlike most other forms of tremor, the tremor associated with Parkinson’s is worse when you are at rest. Note your posture. Most people with Parkinson’s usually stand slightly bent forward, with the head down and the elbows flexed.
Note that Parkinson’s Disease is not difficult to diagnose, except in the very early stages. There is no single test your doctor will perform. Instead, your doctor may run other tests to eliminate other conditions that lead to similar symptoms as Parkinson’s (such as stroke, hydrocephalus, or benign essential tremor). The condition that most often mimics PD is essential tremor, which often runs in families and is most marked with the hands outstretched. Your doctor may also refer you to a neurologist, which is a doctor who specializes in conditions of the nervous system.
Is your expression animated? Do you show signs of a tremor with your arms at rest? Do you exhibit rigidity in your neck or limbs? How easily can you stand up from a sitting position? Do you have a normal gait, and do your arms swing symmetrically as you walk? When given a small push, are you quickly able to resume your balance?
An MRI may help your physician distinguish between PD and conditions that display similar symptoms, such as progressive supranuclear palsy and multi-system atrophy.
If your symptoms are advanced enough to warrant use of medication, then your doctor may prescribe it to see if it curbs any of the symptoms you experience. Diseases that mimic PD tend to respond to treatment less well than PD does. A good response to medication makes PD more likely.
Levodopa/Carbidopa (Sinemet, Parcopa, Stalevo, etc. ), which treats the various motor symptoms seen in both early and advanced PD Dopamine agonists (Apokyn, Parlodel, Neupro, etc. ), which stimulate dopamine receptors to trick the brain into believing it is receiving dopamine Anticholinergics (Artane, Cogentin, etc. ), which are primarily used to help treat tremors MAO-B inhibitors (Eldepryl, Carbex, Zelapar, etc. ), which help enhance the effects of levodopa COMT inhibitors (Comtan, Tasmar), which block the body’s metabolism of levodopa, prolonging the effects
Dancing Yoga Tai Chi Volleyball and tennis Aerobics classes Boxing, which is great for improving stability and coordination
You should also consult your physical therapist for periodic reevaluation of your routine both to ensure maximum effectiveness of the regimen and to keep up with the progression of the disease.
The effects of DBS are often dramatic and doctors may recommend this route for those who experience disabling tremors, those with adverse side effects to medication, or if medications begin losing their efficacy.
