Tremors

What are tremors?

Tremors are a neurological disorder that causes involuntary shaking or trembling in one or more parts of the body. They're typically seen in the hands but can also affect the arms, legs, torso, head and vocal cords. Tremors may happen on their own or be caused by certain medical conditions, medications or other triggers.

At UCSF Benioff Children's Hospitals, our pediatric neurologists are highly trained in identifying the causes of tremors in children and determining the best treatment approach.

Causes of tremors

Many people with tremors have a condition called essential tremor. Essential tremor often runs in families and typically doesn’t cause additional symptoms.

Other causes include:

• Neurological conditions, such as stroke and multiple sclerosis
• Other medical conditions, such as an overactive thyroid gland (hyperthyroidism), diabetes, kidney failure or liver failure
• Traumatic brain injuries
• Certain medications, including corticosteroids (such as prednisone) and some of the drugs used to treat asthma, psychiatric disorders and neurological disorders
• Toxins, such as lead, mercury and pesticides
• Alcohol abuse or withdrawal
• Anxiety and stress
• Not getting enough sleep

It's helpful to understand that everyone has tremors to some degree. In most people, tremors are barely noticeable, but certain factors – such as fatigue or too much caffeine – can make them more pronounced, even in people without a health issue.

Symptoms of tremors

Signs of tremors may include:

• Rhythmic shaking or trembling in the hands, arms, legs, head or torso
• Difficulty with writing, drawing, and using utensils and tools
• Shaky voice

Tremors may be constant or come and go. If severe, they can make it hard to do everyday tasks, such as eating, getting dressed and writing.

Diagnosis of tremors

Tremors in children should be evaluated. The doctor will ask about your child's symptoms and medical history as well as your family medical history. They may perform a neurological exam.

As part of the evaluation, the doctor will assess:

• Does the tremor occur when the muscles are at rest or when they’re working?
• Which body parts are affected?
• Does the tremor affect one or both sides of the body?
• How frequent and sizable are the tremor movements?

Your child's doctor may order tests, such as:

• Blood tests. Blood samples may be needed to measure your child's blood sugar levels or learn how well their thyroid, liver and kidneys are working.
• Brain imaging. If your child has additional symptoms that could be caused by a brain disorder, imaging tests may be necessary.
• Electromyography. If the doctor suspects nerve damage, they may order an electromyogram to test how the muscles respond to nerve stimulation.

Types of tremors

The following are some of the more common tremor types.

Essential tremor

The most common type of tremor is called essential tremor (also known as benign essential tremor or familial tremor). It usually causes a tremor in both hands and arms while the person is moving them, but it can also impact the legs, voice or head. People with essential tremor don't have other neurological symptoms.

Although essential tremor typically appears during adolescence or middle age, it can start at any age. In up to 70% of cases, essential tremor is an inherited condition. If inherited, it may show up earlier in life. The tremor may remain mild or slowly worsen over time.

Cerebellar tremor

This type causes big, slow tremors in the arms, legs, hands or feet that become worse at the end of purposeful movements, such as reaching for an object. It’s caused by damage to the cerebellum (a part of the brain located in the back of the head) and its pathways.

Dystonic tremor

This type causes involuntary muscle contractions, usually in the vocal cords, neck, or arms and legs.

Treatment of tremors

Mild tremors may not need treatment. If your child’s tremors are caused by a medical condition or medication, treating the underlying condition or stopping the medication may reduce or eliminate the tremors.

There is no cure for most types of tremor, but treatment can help control symptoms. Options include:

• Medications. Different oral medicines are available for different types of tremor. Beta-blockers (usually used for cardiovascular issues) may be helpful for certain tremor types, including essential tremor. If beta-blockers fail, anti-seizure medications can be effective for essential tremor. Drugs called anticholinergics may be used to treat dystonic tremor.
• Botox injections. Botox can be used to treat dystonic head tremor and hand tremor, as well as essential tremors that don’t improve with oral medications.
• Surgery. The most common procedure for tremors is called deep brain stimulation (DBS). With DBS, a surgically implanted device delivers electrical impulses to the part of the brain that’s causing the tremor, relieving symptoms. Adults with essential tremor may be candidates for a minimally invasive procedure called focused ultrasound.
• Therapy. Physical, speech and occupational therapy may help your child manage tremor symptoms and overcome everyday challenges.

The doctor may also suggest lifestyle modifications, such as:

• Reducing stress
• Getting plenty of sleep
• Avoiding caffeine
• Wearing clothes that are easier to get on and off (for example: slip-on or Velcro-closing shoes, clothing without zippers or buttons)
• Using heavier eating utensils (which can help stabilize the hands)