Tremor during movement (intentional) occurs with lesions of the cerebellum, brain stem and red nuclei. Changes in brain structures develop against the background of TBI, strokes, tumors, degenerative diseases of the central nervous system, poisoning, and an overdose of certain drugs. The symptom is observed in isolation or combined with postural trembling and resting tremor. Neurological examination data and neuroimaging methods are used to determine the cause of movement tremor. Treatment is carried out with the use of valproates, beta-blockers, benzodiazepines. Operations are performed according to indications.
Tremor during movement or intentional trembling is a variant of hyperkinesis that occurs in the final phase of purposeful movements and intensifies as you approach the goal. Affects fine motor skills, limits or makes it impossible to perform precise movements. Absent at rest. It is often supplemented by the inability to maintain a fixed muscle tension, increased fatigue, and muscle hypotension.
The jitter frequency is 3-5 Hz. With damage to the cerebellum, a combination of tremor during movements and cerebellar ataxia is observed. The symptom develops against the background of damage to the superior cerebellar peduncle or lateral cerebellar nuclei. The severity varies significantly, both slight jerky and large-scale movements are possible, turning into asynergy or chorea. In pathological foci of other localizations, intentional tremor is combined with other types of trembling.
This type of cerebellar ataxia develops over a period of several hours to one week. Movement tremor is associated with unsteady gait, loss of synergy, nystagmus, dysarthria, and instability in the Romberg position. The most common cause of this symptom complex is an ischemic stroke in the basin of the vertebrobasilar artery. It is manifested by dizziness, diplopia, dysarthria, dysphagia, hearing impairment. Alternating syndromes are often detected.
Less common is movement tremor due to hemorrhagic stroke. The symptom is also provoked by moderate and severe brain injuries. When the cerebellum is compressed by an intracerebral hematoma, it can occur both immediately and some time after damage. Sometimes the cause of the sudden onset of intentional tremor is encephalitis and Guillain-Barré syndrome. The symptom is observed in some patients with obstructive hydrocephalus, metabolic disorders and acute intoxications.
Tremor when moving
The same symptoms are noted as with an acute variety of pathology, but the clinical picture is formed in the period from one week to several months. Movement tremor may be accompanied by the following pathological conditions:
There may be a gradual increase in symptoms over several months or years. Violation is observed in such cases as:
Multiple sclerosis is characterized by a variable clinical picture with a predominance of paresis. Tremor during movements may appear suddenly or progress gradually, combined with other signs of cerebellar damage: static and dynamic ataxia, asynergy, chanted speech, megalography. The involvement of the dentate-red nuclear pathways is accompanied by an increase in trembling, especially when changing the direction of movement. In severe cases, the tremor spreads from the arms to the trunk and head.
The first symptoms of this hereditary disease usually appear before the age of 3 years. Intentional tremor is the leading symptom of the trembling form; it may be absent in other variants of the course of Wilson's disease. Complemented by epileptic seizures, bradilalia, bradykinesia, severe psychoorganic syndrome.
The leading symptoms of a hereditary disease are intentional and postural trembling. Sometimes there is a resting tremor. The hands are most commonly affected. Involvement of the head, tongue, lips and chin is possible. The symptom intensifies with emotional experiences and physical exertion. Due to severe tremor in patients with essential tremor, working capacity decreases, there is constant psychological discomfort, which provokes the development of neurotic disorders.
The cause of the symptom is determined by a neurologist. At the initial stage of the examination, the specialist finds out when the tremor first appeared during movements, how often it appears, with what symptoms it is combined. To form a complete picture of disorders of the nervous system, a neurological examination is performed. Objective tests, instrumental and laboratory techniques are used to assess the nature and severity of trembling.
As objective tests, tremor assessment scales are used, the patient is asked to pour water from a bowl, draw a spiral. During the Gibson-Khersonsky test, the patient's handwriting is studied when writing with his eyes closed. The list of additional studies includes the following methods:
Neurologist's consultation
Tremor treatment during movements includes etiopathogenetic and symptomatic measures. The leading role is played by symptomatic drug therapy. To correct intentional tremor, drugs of the following groups are used:
Non-drug methods include measures to correct trembling and adapt to disorders. Patients are advised, if possible, to exclude situations that increase the intensity of tremor during movement. To minimize the negative impact of the symptom on the performance of household activities, it is recommended to use spoons and forks with thick handles, special fountain pens, knives and scissors with rounded ends, and telephones with voice control.
Orthoses that fix the hand in the area of the wrist joint help to reduce the severity of intentional tremor. To master new motor stereotypes, patients are prescribed exercise therapy and occupational therapy in combination with reflexology and massage. Etiopathogenetic measures include vascular and anti-inflammatory drugs, hormonal drugs.
Patients with cancer may need chemotherapy and radiation therapy. Tremor during movements on the background of alcoholism and drug addiction is an indication for the treatment of addictions in a narcological hospital with subsequent rehabilitation.
The tactics of surgical intervention is determined by the characteristics of the pathological process that provoked tremor during movements: