Does hand tremor necessarily mean Parkinson's disease?

Author: Zhou Yingyi and Ou Leyi Shanghai University of Medicine and Health Sciences

Reviewer: Chen Haibo, Chief Physician, Beijing Hospital

According to surveys, there are currently millions of people with hand tremors in my country, which is close to half of the total number of people with hand tremors in the world. When it comes to hand tremors, we can easily associate them with Parkinson's disease. It is reported that the onset age of Parkinson's disease is mainly over 50 years old, but now more than 50% of the millions of people with hand tremors in my country are concentrated in the age of 20 to 30 years old. Therefore, it is believed that hand tremors are not necessarily Parkinson's disease. In fact, hand tremors are just one of the common manifestations of Parkinson's disease.

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What is hand tremor?

Hand tremor, also known as tremor, can be clinically divided into resting tremor, kinetic tremor, postural tremor, dystonic tremor, etc. Common causes include Parkinson's disease, hepatolenticular degeneration, hepatic encephalopathy, cerebellar brainstem lesions, cerebral arteriosclerosis, cerebral ischemia, drug poisoning and dementia. Hand tremor is mainly manifested as involuntary and rhythmic tremors of the hands, but the "root cause" is mostly in the cranial nerves, which can be divided into physiological and pathological. Clinically, hand tremor is more common in middle-aged and elderly people. But nowadays, with the increasing pressure of social competition, hand tremor is gradually becoming younger. Many young people have emotional tension, fear, severe physical pain, excessive fatigue, etc., followed by physiological tremor.

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1. Characteristics of physiological tremor Physiological tremor refers to slight tremors of the limbs and head when there is no support. It is usually not visible and only occurs when one is tired or excited. It has a small amplitude, fast speed, and irregular pattern, and disappears when the emotions stabilize.

2. Characteristics of pathological tremor Pathological tremor mainly occurs in people with Parkinson's disease, alcoholism, cerebellar lesions, dementia, etc., and often persists significantly. Epidemiological surveys show that there are 3.62 million Parkinson's disease patients in China, and the prevalence of Parkinson's disease in people over 60 years old is 1.37%; there are more than 700,000 people suffering from alcohol poisoning in China every year; the incidence of essential tremor in the general population is 0.9%, and it reaches 4.6% in people over 60 years old; the number of people suffering from Alzheimer's disease in China reaches 6 to 8 million.

According to the above data, it is not difficult to see that hand tremors are relatively common in my country. Commonly used treatment methods are:

(1) Physical therapy : When your hands are shaking, you can increase your skill level through appropriate exercises such as repetitive movements.

(2) Drug treatment : Drug treatment requires a clear diagnosis from a doctor and should not be taken on your own. This is because the elderly take more medications, including more medications to control hand tremors, and taking medication on your own is risky. Traditional Chinese medicine generally considers using drugs to treat liver wind or yin deficiency and yang hyperactivity. Modern medicine often uses drugs such as pramipexole hydrochloride tablets and propranolol, which are characterized by rapid effects, but also obvious adverse reactions, and need to be taken for a long time, and cannot be cured.

(3) Acupuncture treatment : Acupuncture is mainly performed on local acupoints. Acupoints such as Hegu, Neiguan, Waiguan, and Quchi can be selected for acupuncture, which can achieve a certain therapeutic effect.

(4) Surgical treatment : such as thalamotomy, deep brain stimulation, etc.

Complications related to hand tremor

Hand tremors in the elderly can easily affect their daily lives, causing inconveniences and even affecting their mood, making them unwilling to interact with others and reducing their quality of life.

Mild hand tremors are generally physiological tremors. Everyone has them, but the degree varies. They are usually invisible. They are obvious when you are emotionally excited and disappear when you are emotionally stable. If the hand tremors start from one hand, you need to be alert to Parkinson's disease. The treatment of Parkinson's disease is mainly based on medication. There are many types of drugs, more than 10 kinds. The medications for patients of different ages are different, and doctors need to make judgments. Patients cannot take medications on their own, and during the medication process, they also need to adjust the dosage according to changes in the condition, and cannot stop taking medication suddenly. If the elderly have bilateral hand tremors, which are more obvious when picking up things, some patients also have nodding or shaking movements in addition to hand tremors. They last for more than 3 years and the cause cannot be found. It is often primary tremor, and the treatment is mainly controlled by drugs, and beta-blockers can be used. Beta-blockers also have antihypertensive effects. If patients with primary tremor have hypertension, beta-blockers are more symptomatic. Cerebrovascular disease can also be combined with hand tremors, the most common of which is cerebral infarction. Generally, patients with cerebral infarction do not have hand tremors, but if lacunar infarction affects specific parts, such as the striatum, it can also induce hand tremors, which requires an experienced doctor to diagnose. If the patient has more comorbidities, such as diabetes, heart disease, and chronic heart failure, be alert to hypoglycemia, especially when diabetic patients take hypoglycemic drugs.