Parkinson's Disease and Movement Disorders

Tremor

Tremor – an involuntary, rhythmic movement produced by the contractions of opposing muscles – commonly affects the arms, legs, neck, tongue, chin, or vocal cords. It can occur as a symptom of a neurological disorder (such as Parkinson's disease) or be related to medication use, alcohol consumption or withdrawal, or an overactive thyroid. Most cases of tremor are due to a condition called "essential tremor," the most common movement disorder in adults, affecting 13 million people in the United States.

Neurologists and neurosurgeons at NewYork-Presbyterian Hospital's two movement disorder centers, Columbia's Center for Parkinson's Disease and Other Movement Disorders and Weill Cornell's Parkinson's Disease and Movement Disorders Institute, have extensive experience in the diagnosis and treatment of tremor. Since 50 percent or more of patients with essential tremor may have inherited a gene for the disorder, genetic counseling is also available for the families of people diagnosed with essential tremor.

Symptoms

In people with essential tremor, the most frequent symptom is "action tremor," which occurs when the affected body part is used to perform activities such as writing, pouring, or eating. Essential tremor is usually progressive; in severe cases, people with tremor become very dependent on others to help them carry out their normal activities.

Diagnosis

NewYork-Presbyterian physicians diagnose tremor using a thorough physical examination and neurologic assessment to determine what symptoms are present and when and how they occur. They may order other tests, such as MRI scans, to rule out other causes of symptoms.

Treatment

Our doctors first determine if the cause of a patient's tremor is something else that can be treated. Medical treatment may include beta blockers, primidone, and other drugs for essential tremor, and levodopa or dopamine-like drugs for Parkinsonian tremor. Doctors may also recommend eliminating substances from the diet that can trigger tremors, such as caffeine and other stimulants.

If tremor is severe and does not respond to medical treatment, doctors may consider surgical treatment. "Deep brain stimulation" (DBS) has become an important tool in the treatment of tremor. NewYork-Presbyterian is one of the busiest and most prestigious centers offering this treatment. With DBS, neurosurgeons implant a device that acts like a pacemaker for the brain, reducing or eliminating the activity of the areas overly active in tremor and minimizing symptoms. DBS also enables many patients to reduce their dependence on medications.

Innovative nonsurgical high-intensity focused ultrasound treatment may be an option for those with significant tremors. MR-guided high-intensity focused ultrasound is a non-invasive procedure that uses beams of ultrasound energy to precisely target and destroy small areas of brain tissue that are causing symptoms, particularly tremors. The procedure is performed while the patient is awake in an MRI scanner allowing our specialists to precisely plan and target specific brain cells with little to no harm to surrounding tissue and minimal side effects. Learn more here.

Rehabilitation

Patients with tremor often benefit from physical therapy, which can help improve coordination. Rehabilitation experts at NewYork-Presbyterian Hospital are available to:

• Evaluate muscle strength and motor skills and develop an individualized program to maintain existing physical function.
• Recommend adaptive devices to help tremor, and canes, walkers, wheelchairs, and equipment for the home if walking and balance are affected.
• Discuss ways to modify activities, conserve energy, and simplify work.

Research and Clinical Trials

Investigators at both NewYork-Presbyterian Hospital campuses are conducting basic science and clinical research to learn more about the causes of tremor and to find new and more effective ways to diagnose and treat it.