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Causes & Symptoms

What is a tremor?

Tremor is actually a movement disorder. It is most common on the hands or arms, but the trunk or head can also be affected. At least every hundredth person in Germany suffers from an essential tremor, i.e. a tremor without a recognizable underlying neurological disease. In this form, several members of the family are often affected. The tremor increases when the muscles are tensed, i.e. when you want to write, drink or eat. In Parkinson's patients it is exactly the opposite. Here the tremor is reduced when one carries out activities.

A tremor can occur in different situations:

  • Rest tremor:
    It occurs when the muscles are completely relaxed, for example when the hand is on a table. When the person concerned has to concentrate on an upcoming task, the tremor usually intensifies. A resting tremor is typical in Parkinson's disease.
  • Action tremor:
    There are three subspecies here, hold, movement and intention tremors.
    The postural tremor always occurs when the person concerned needs strength to hold the finger, arm or leg in position. Typical of this is the tremor when holding a glass of water. A postural tremor is a characteristic of essential tremor, but it also occurs in Parkinson's patients.
    The movement tremor shows up with certain movements. For example, it hinders writing or playing the piano. Movement tremor is also typical of essential tremor.
    In the case of intention tremor, the tremor increases when the goal of a certain movement is reached or “within reach”. This happens, for example, when a finger is moved to a certain point.

Causes: how does a tremor develop?

There are several causes of tremor.

Increased physiological tremor

This form of tremor mostly affects the hands and occurs primarily as a postural tremor. The tremor is clearly visible, but is usually not perceived as annoying. The cause can be a wide variety of diseases, such as an overactive thyroid or parathyroid, calcium deficiency, hypoglycaemia or vitamin B12 deficiency. Disorders of kidney function, stress, exhaustion, cold or medication can also cause the tremor.

Parkinson's tremor

In the course of the disease, nerve tracts in the midbrain perish and thus cause the movement disorder.

Essential tremor

The research results so far indicate that a nerve control circuit between the cerebellum, brain stem and midbrain is disturbed. If neurosurgeons or accidents interrupt the corresponding control loop, the tremor also disappears.

Symptoms: signs of tremor

There are several different signs that you have tremor.

Symptoms of increased physiological tremor

A high frequency of trembling movements is typical here. If the cause of the tremor is found and corrected, the tremor will go away on its own.

Symptoms of Parkinson's Tremor

The typical tremor in Parkinson's patients is resting tremor. Sometimes a postural tremor can also occur. The tremors mainly affect the feet and hands, but rarely the head. Sometimes the tremor also affects the jaw and tongue.

Symptoms of essential tremor

The essential tremor primarily affects the hands and arms. It often begins with a slight tremor in the dominant hand, later both hands are affected. The writing is becoming increasingly illegible, and eating and drinking are becoming more and more difficult. If the head, voice or facial muscles are affected, communication problems often arise. Symptoms can also worsen under stress. Many of those affected then withdraw more and more from their social environment. The course varies from person to person. Some suffer from a weak tremor at an early age, which then lasts for life. For others, the symptoms start late and quickly increase. Cognitive disorders and changes in personality can also occur, especially in the late stages. If the tremor affects the legs, people feel very insecure when they stand. At the beginning they try to compensate for the uncertainty by frequently switching to the other leg or look for a support. In the further course, free standing becomes impossible and falls increase.


If you drink alcohol in moderation, the symptoms improve for about three to four hours in the short term. But if the alcohol in the liver is broken down, the tremor worsens. Therefore, it is better to avoid alcohol.


This is how we determine a tremor

In order to track down the causes of your tremors, our doctors first observe whether it is a resting, holding or movement tremor. You will be instructed to perform certain activities, such as bringing a cup to your mouth and holding it there. If the hands shake uncontrollably, it is an essential tremor. But a writing sample also gives us information about which form of tremor you are dealing with. The frequency of the movement provides further information. It is generally lower in Parkinson's tremor than in other forms of tremor.

Further examinations for a reliable diagnosis

If an increased physiological tremor has been diagnosed, we use laboratory tests to determine the underlying metabolic disorders. Sometimes a neurological or internal examination can also provide the decisive information.