Tremor occurs in up to 80% of people with Parkinson’s.
The tremor often starts on one side of the body and can appear at rest or during active movements, but not everyone with Parkinson’s has a tremor at all.
What is a tremor?
A tremor is an involuntary, rhythmic muscle contraction that causes shaking. In conditions like Parkinson’s and Essential Tremor (ET), tremors manifest differently.
Parkinson’s tremors often start on one side of the body and can appear at rest (e.g., a ‘pill-rolling’ motion in the hand) or during action (e.g., holding a book). Parkinson’s tremors are typically slower and may improve with medication like levodopa. According to scientific literature, resting tremor is present in approximately half of people with Parkinson’s, while action tremor (which includes both postural and kinetic tremor) is present in about a third of patients (1). This means that approximately 20% of Parkinson’s patients have no tremor.
Tremors in ET usually occur during action (e.g., writing, holding a posture) and are often more rapid than a Parkinson’s tremor. ET affects both sides of the body from the beginning and can involve the hands, head, and voice. ET tremors can be familial and may improve with some medications like propranolol.
Understanding these differences is crucial for accurate diagnosis and effective treatment. Tremor can significantly impact daily activities, such as writing, eating, and dressing (2). Medication may help control these tremors, and assistive technology can help minimise the impacts on daily life.
What types of tremor occur in Parkinsons?
Resting tremor
- Resting tremor can occur in different parts of the body, but usually starts in a finger or hand on one-side of the body. This is the stereotypical tremor often associated with Parkinson’s. It sometimes looks like someone is rolling something between their thumb
- Oropharyngeal resting tremor in structures such as the tongue or larynx explicitly affects swallowing physiology (4).
Action tremor
- Postural tremor occurring when maintaining a position.
- Kinetic tremor occurring during movement.
Internal tremor
Affects internal body parts and is less visible.
It’s important to note that both ET and Parkinson’s are movement disorders and sometimes they can be mistaken for each other. However, there are many differences between the two conditions, and proper and early diagnosis is important for receiving the right treatment and support. ET is also 8 times more common than Parkinson’s in the general population and generally runs in families, so is also known as familial tremor.
How do I access assistive technology (AT) for my tremor?
Accessing occupational therapy services can provide you with a good start as to what AT is available. You can also go look at assistive technology retailers or disability equipment suppliers. These stores specialise in providing a wide range of products designed to assist you in your daily activities, mobility, communication, and overall quality of life.
It’s advisable to explore all available pathways to find the support that best suits your individual needs. Look to:
- getting a GP referral to an OT with Parkinson‘s experience
- your state-based Parkinson’s organisation for advice on OTs and stores to access
- private health to see what is covered in relation to OT consultations and AT expenses
- NDIS or My Aged Care plan supports for OT and AT costs.
Infosheet under review
References:
(1) Gupta, D. K., Marano, M., Zweber, C., Boyd, J. T., & Kuo, S.-H. (2020). Prevalence and Relationship of Rest Tremor and Action Tremor in Parkinson’s Disease. Tremor and Other Hyperkinetic Movements, 10(1), 58. https://doi.org/10.5334/tohm.552
(2) Farashi, S., Sarihi, A., Ramezani, M., Shahidi, S., & Mazdeh, M. (2023). Parkinson’s disease tremor prediction using EEG data analysis-A preliminary and feasibility study. BMC Neurology, 23(1), 420. https://doi.org/10.1186/s12883-023-03468-0
Pasquini, J., Ceravolo, R., Qamhawi, Z., Lee, J.-Y., Deuschl, G., Brooks, D. J., Bonuccelli, U., & Pavese, N. (2018). Progression of tremor in early stages of Parkinson’s disease: a clinical and neuroimaging study. Brain, 141(3), 811-821. https://doi.org/10.1093/brain/awx376
(3) Pirker, W., Katzenschlager, R., Hallett, M., & Poewe, W. (2023). Pharmacological Treatment of Tremor in Parkinson’s Disease Revisited. Journal of Parkinson’s disease, 13(2), 127–144. https://doi.org/10.3233/JPD-225060
(4) Dumican, M., Harper, K., & Stankiewicz, J. (2024). The Effect of Oropharyngeal Resting Tremor on Swallowing Function in a Clinical Cohort of People with Parkinson’s Disease. Dysphagia, 39(6), 1100–1111. https://doi.org/10.1007/s00455-024-10688-0
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