Tremor


#1

Tremor –timeline

2002 Tingling/pins & needles in right arm after gp misdiagnoses my blepharospasm as stress symptom and gives me Sertraline
2003 Head tremor a couple of months after being given a drug called Sulpiride to “treat” my movement disorder

2010 Tremor right arm
Had been having a bad week. Went shopping with my trike. Tried to walk in shop had trouble just walking across to another till - so slow was hardly moving (bradykinesia). Had to call a cab home & driver very off when he saw the trike…

Few days later tried going to the shops again - but on way home right arm very uncomfortable & terrible in the evening - pain all the way down, couldn’t do anything with it & hurt when I moved it . was in floods of tears. Called the gp for home visit… I was just standing telling her all nonsense I was getting at the hospital , feeling pretty stressed. My right arm hanging down and it started to tremor very strongly. I said isn’t that tremor?

2011 Neurology consultation - was trying to do the fingertap. Finger & thumb of each hand in position ready to start but nothing happened.(Akinesia). Consultant indicates I should put my hands down. So they are resting on my ribcage – I’m lying down. Then he gestures to my right hand and I look down. It is tremoring away. I said it doesn’t normally do that.
I was very stressed. He had started off with denials and I had to insist on a physical examination after which he admitted “You tick all the boxes” (ie. for PD)

2012 Tremor left arm preceded by pain in shoulder blade and numbness and tingling in the left arm.

Head tremor in Parkinson’s disease. Roze E, Coêlho-Braga MC, Gayraud D, Legrand AP, Trocello JM, Fénelon G, Cochen V, Patte N, Viallet F, Vidailhet M, Pollak P, Apartis E. Mov Disord. 2006 Aug;21(8):1245-8.

Head tremor is a typical feature of essential tremor. Patients with sporadic Parkinson’s disease can have tremor of the tongue, lip, or chin, but classically do not have head tremor.

We describe five patients with Parkinson’s disease and head tremor in whom clinical and neurophysiological findings suggested that head tremor was a manifestation of Parkinson’s disease

Clinical Approach to Parkinson’s Disease: Features, Diagnosis, and Principles of Management J.Massano & K.P.Bhatia Cold Spring Harb Perspect Med. 2012 Jun; 2(6):

A note should be made if there is a typical resting pill-rolling tremor and bradykinesia. If this is present in an asymmetric fashion then it is almost pathognomonic for PD.

Description of Parkinson’s Disease as a Clinical Syndrome S. FAHN (in PARKINSON’S DISEASE THE LIFE CYCLE OF THE DOPAMINE NEURON Editors H.J. FEDEROFF, R.E. BURKE, S.FAHN, AND G.FISKUM ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Vol. 991 June 2003)

Helpful in the diagnosis is that the tremor due to PD is a rest tremor (tremor appears with the affected body part is at rest). Rest tremor can be intermittent at the beginning, being present only in stressful situations; eventually it tends to be present most of the time and worsens in amplitude with stress or excitement.

https://www.researchgate.net/publication/307538277_Clinical_Rating_Scale_for_Tremor

Clinical Rating Scale for Tremor·S.Fahn, C.Marin, E.Tolosa January 1988 (in Jankovic & Tolosa Parkinson’s Disease and Movement Disorders 1988)