Tremor at rest accompanies Parkinson's disease, juvenile and secondary parkinsonism, some degenerative diseases of the central nervous system. Represents involuntary oscillatory movements at rest. May be combined with other types of tremor, muscle rigidity, hypokinesia, gait disturbances, postural disorders. To determine the cause of the symptom, a neurological examination is performed, MRI, electrophysiological studies, SPECT, PET-CT are prescribed. Treatment is with antiparkinsonian drugs, sometimes including surgery.
Tremor at rest is a type of hyperkinesis, which is a violent involuntary movement of an oscillatory nature involving any part of the body that occurs in the absence of purposeful motor activity. It has a rhythmic character. Occurs around a certain fixed point. Appears as a result of synchronous or alternating contractions of antagonist muscles. Resting tremor is medium-amplitude, its frequency characteristics are 3-6 Hz. Often combined with other types of trembling (postural, intentional).
Trembling movements are local or generalized. They differ according to the motor pattern. The tremor of the fingers in appearance often resembles “rolling pills” or “counting coins”. Head tremor can occur according to the “yes-yes” or “no-no” type, limb tremor - according to the type of pronation-supination, flexion-extension. The first place in prevalence is occupied by a tremor of the fingers. Further, in descending order, there are trembling of the lower jaw, lips, tongue, head, etc.
Resting tremor is the most typical type of tremor in this pathology. It is most pronounced in tremulous and trembling-rigid forms of the disease. A typical feature of tremor in Parkinson's disease is its asymmetric character. The symptom is combined with hypokinesia, rigidity and postural disorders. The severity of manifestations gradually increases.
The disease has a hereditary character, manifests itself at a young age (up to 25 years). It is manifested by tremor, muscle rigidity and hypokinesia. Unlike Parkinson's disease, juvenile parkinsonism is not characterized by asymmetry of symptoms, the disorders are equally pronounced on both sides. Statokinetic tremor predominates, rest tremor is not detected in all patients, it can join in the later stages of the disease.
Resting tremor
Postural tremor is typical for this type of parkinsonism. Trembling at rest is an optional symptom that can be found in patients with advanced forms of pathology. The disorders are symmetrical, the manifestations progress faster than in patients with primary parkinsonism, the severity of tremor varies depending on the cause of the disease.
Secondary parkinsonism occurs after traumatic brain injuries, encephalitis, and general infections. It can form against the background of intracerebral tumors, frequent episodes of hypoglycemia, hydrocephalus, manganese intoxication in drug addicts. The cause of drug-induced parkinsonism is the use of antipsychotics and anticonvulsants. After extensive strokes and lacunar infarctions, with cerebral atherosclerosis, vascular parkinsonism is observed.
This term in neurology is understood as degenerative pathologies of the central nervous system with parkinsonism syndrome. As with other types of secondary disorders, rest tremor is not the main symptom, it occurs in some patients:
Neurologists are engaged in determining the cause of tremor at rest. The specialist finds out when the symptom first appeared, how it changed over time, what manifestations it accompanied. Examines the history of life, identifies circumstances that could contribute to the development of secondary parkinsonism. Performs a neurological examination using the Clinical Tremor Rating Scale to determine the severity of the symptom. To clarify the diagnosis, the following procedures are performed:
Neurologist examination
Treatment of diseases accompanied by tremor at rest includes drug and non-drug measures. The purpose of non-drug methods is to improve social adaptation and increase the ability to self-service. The drug component of therapy is aimed at reducing the severity of trembling and eliminating the causes of the symptom in secondary parkinsonian manifestations.
In the early stages of Parkinson's disease, dopamine receptor agonists, MAO inhibitors, amantadine are used. Monotherapy is possible, but the preferred option is the use of several drugs. With the progression of symptoms, levodopa is included in the treatment plan. The appointment of other drugs and combined schemes allow you to delay the start of taking levodopa, and subsequently reduce the required dose of medication.
In secondary disorders, symptomatic therapy is carried out with the means listed above. The effectiveness of levodopa in such cases is lower than in the primary nature of the disorders. At the same time, pathogenetic measures are carried out. Cancel or replace drugs that provoked the occurrence of drug-induced parkinsonism. Prescribe oxygen therapy, vascular or neurometabolic drugs. For tumors, chemotherapy and radiation therapy are used.
The indication for surgical intervention is the ineffectiveness of conservative methods. Possible deep brain stimulation, stereotaxic destruction of the subthalamic nucleus and ventrolateral nucleus of the thalamus. Some neoplasms are subject to excision using open and minimally invasive techniques. In vascular pathologies, AVM removal, aneurysm embolization, arterial reconstruction, and anastomosis formation are possible.