Essential tremor, Parkinson's disease or something else?


Q: My hand tremors begun after a spring-flu this year. The tremors happen only while eating or brushing teeth. Sometimes the tremor is so severe that I have to eat with my right hand (I'm left-handed). In beginning of May my shoulder and arm became really sore, it's hard to get up from my bed. Sometimes it hurts both sides and sometimes only the other, the left side is usually the worse. I went to the general practitioner and she gave me cortisone shots to both arms 3 times. It helped only temporarily and the pain snuck back in. The first shot was the most effective one and the other's didn't help that long. I was also sent to 2 specialists, a rheumatologist and a neurologist. They had almost all the blood-test you can think of taken of me, but most of them became back normal. Rheumatologist suspects I have polymyalgia rheumatica and neurologist diagnose was incipient Parkinson's disease. Rheumatologist just waits for a month and sees if the symptoms will vanish or stay the same and neurologist has sent me to CT-scan for my brain (still waiting to get there). The pain seems to get worse and I'm left to wait. I can't have the most effective painkillers because of my warfarin medication. It's also concerning that the doctors throw around diagnoses (quite severe ones) without too much ground or evidence and leave me alone with so many questions. I have spent my time reading, and I can't believe that the neurologist suspects I have Parkinson't disease. I don't have rest tremors at all, neither I have the other symptoms for it. I have also read about the other reasons for hand tremors and essential tremor seems the most likely to me, since I remember my mother having hand tremors too. I also read that some type of beta-blockers can worsen the essential tremor, could this be in my case? Could I just have Polymyalgia Rheumatica and Essential tremor worsen by beta-blockers?


A:   Parkinson disease is a disabling, progressive condition that is predominantly thought of as a movement disorder that commonly affects middle-aged and elderly individuals. The tremor is the most common initial symptom, occurring in approximately 70% of patients. It is described by patients as shakiness or nervousness. It may differ considerably, showing up only with stress, anxiety, or fatigue or it may occur only when supporting weight with the affected limb, such as experiencing arm tremor when getting out of a low chair. But along with the tremor, Parkinson’s disease has other criteria to be diagnosed as: slow movements, stiffness or rigidity, depression, slowness in thinking and speaking and a general feeling of weakness.According with your description what you are experiencing better correspond to an Essential Tremor which usually begins in one upper extremity and soon affects the other. Essential tremor rarely extends from the upper extremity to the ipsilateral leg. Tremor may be intermittent initially, emerging only during periods of emotional activation. Over time the tremor becomes persistent. A degree of voluntary control is typical, and the tremor may be suppressed by skilled manual tasks and during sleep.

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