Tremor is an uncontrollable shaking or oscillation of a part of the body. So for instance, head tremor causes the head to shake and similarly hand tremor causes shaking hands. Other parts of the body that can sometimes be affected include the arms, eyes, face, vocal cords, trunk, and legs.
Dystonic tremor is a type of tremor which occurs in conjunction with dystonia, a neurological disorder where incorrect messages from the brain cause muscles to be over-active resulting abnormal postures or unwanted movement. Dystonic tremor usually appears in young adulthood or mid-life.
Symptoms of dystonic tremor can be quite variable and sensory tricks may temporarily make the tremor disappear (for instance for head tremor a light touch on the chin or placing of the head against a headrest). Dystonic tremor can sometimes make managing everyday tasks difficult, cause tiredness and/or be isolating in social situations. As with all types of dystonia, stress or anxiety can make the symptoms worse.
For some people dystonic tremor symptoms can be temporarily reduced by a small amount of alcohol, but often people notice a rebound worsening the next day, and clearly the long term adverse effects of high levels of consumption of alcohol are well known
Dystonic tremor and essential tremor
It is important to distinguish dystonic tremor from the most common type of tremor, essential tremor. Essential tremor is a tremor that usually affects arms, hands or fingers. It may also affect additional parts of the body such as the head.
The key differences between essential tremor and dystonic tremor are as follows:
- Essential tremor does not appear in combination with dystonia.
- Essential tremor has a regular oscillation while the movement in dystonic tremor is usually irregular.
- In most cases of essential tremor the arms, hands or fingers are affected symmetrically. In contrast, dystonic tremor can affect other parts of the body, such as the head, without the hands or arms being affected (although dystonic tremor can also sometimes affect the hands).
- Dystonic tremor can sometimes be temporarily relieved by a sensory trick but this is not the case with essential tremor.
Types of dystonic tremor
There are a number of different types of dystonic tremor:
- The tremor appears in the same part of the body as the dystonia; so for instance a neck dystonia may cause the head to twist (a common symptom of neck dystonia) but also to shake.
- The tremor appears in a different part of the body to the dystonia; so for example a neck dystonia which causes the head to twist (but not to shake) may be accompanied by a shaking of the hand.
- The tremor is not accompanied by any other dystonic symptoms but there is another reason to believe dystonia is the cause (for instance because of a family history of dystonia).
- The tremor appears without any other dystonic symptoms or reasons to suspect dystonia but the symptoms appears to be dystonic (for instance the movement is irregular or affecting just one arm rather than both). In practice, this type of dystonic tremor can sometimes be difficult to distinguish from essential tremor.
Managing dystonic tremor
The methods of managing dystonic tremor are similar to those used for managing dystonia.
Botulinum toxin injections
If the tremor is focal to one or two areas of the body, botulinum toxin injections which weaken the overactive muscles can be an effective treatment. Injections need to be repeated every three months or so. In cases where little improvement results from the injections, it may be because they have not been accurately targeted, or the dose needs adjusting. Sometimes an electromyographic (EMG) or ultrasound machine is used to identify the appropriate muscles to inject. Botulinum toxin is particularly helpful for head tremor, but is much less often helpful for arm tremor.
A number of different oral medications are effective for some patients. Some work by interfering with neurotransmitters, the chemical substances that carry messages within the brain. Others are designed to relax the muscles and reduce shaking. To be effective, they have to be taken continuously. Drugs can cause side effects. You can read more about the drugs used for dystonia here.
Deep brain stimulation (DBS) may be an option where the dystonic tremor is severe and patients do not respond to other methods of managing the tremor. In this treatment, electrodes are planted into the brain to help ‘rebalance’ movement and to control posture. The electrodes are powered by a battery implanted in the chest.
If coping with the tremor in everyday life is causing problems with activities such as eating or cooking, occupational therapists can advise on specialist equipment that can aid with a range of different tasks.
If you would like more information, please called our helpline on 0845 458 6322.
If you would like to read a more detailed article on head tremor click here.
The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment.It should not be used in place of a professional consultation with a doctor.
The Dystonia Society is not responsible for the consequences of your decisions resulting from the use of this information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you receive from us. If you have any health care questions, please consult the relevant medical practitioner.
Last reviewed March 2013