Editing Tremor (section)

==Types==
Tremor is most commonly classified by clinical features and cause or origin. Some of the better-known forms of tremor, with their symptoms, include the following:
* '''[[Cerebellar]] tremor''' (also known as '''[[intention tremor]]''') is a slow, broad tremor of the extremities that occurs at the end of a purposeful movement, such as trying to press a button or touching a finger to the tip of one's nose. In classic cerebellar tremor, a lesion on one side of the brain produces a tremor in that same side of the body that worsens with directed movement. Cerebellar damage can also produce a "wing-beating" type of tremor called rubral or Holmes' tremor&nbsp;— a combination of rest, action, and postural tremors. The tremor is often most prominent when the affected person is active or is maintaining a particular posture. Cerebellar tremor may be accompanied by other manifestations of [[ataxia]], including [[dysarthria]] (speech problems), [[nystagmus]] (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck. Titubation is tremor of the head, hands, and torso and is of cerebellar origin.{{medical citation needed|date=July 2023}}
* '''[[Dystonic]] tremor''' occurs in individuals of all ages who are affected by [[dystonia]], a movement disorder in which sustained involuntary muscle contractions cause twisting and repetitive motions or painful and abnormal postures or positions.  Dystonic tremor may affect any muscle in the body and is seen most often when the patient is in a certain position or moves a certain way.  The pattern of dystonic tremor may differ from essential tremor. Dystonic tremors occur irregularly and can often be relieved by complete rest. Touching the affected body part or muscle may reduce tremor severity (a ''[[geste antagoniste]]'').  The tremor may be the initial sign of dystonia localized to a particular part of the body. The dystonic tremor has usually a frequency of about 7&nbsp;[[Hertz|Hz]].<ref name=":0">{{Cite journal|last1=Chen|first1=Wei|last2=Hopfner|first2=Franziska|last3=Becktepe|first3=Jos Steffen|author4-link=Günther Deuschl|last4=Deuschl|first4=Günther|date=2017-06-16|title=Rest tremor revisited: Parkinson's disease and other disorders|journal=Translational Neurodegeneration|language=En|volume=6|issue=1|pages=16|doi=10.1186/s40035-017-0086-4|issn=2047-9158|pmc=5472969|pmid=28638597 |doi-access=free }}</ref>
* '''[[Essential tremor]]''' (sometimes inaccurately called '''benign essential tremor''') is the most common of the more than 20 types of tremor.  Although the tremor may be mild and nonprogressive in some people, in others, the tremor is slowly progressive, starting on one side of the body but affecting both sides within 3 years. The hands are most often affected but the head, voice, tongue, legs, and trunk may also be involved.  Head tremor may be seen as a vertical or horizontal motion. Essential tremor may be accompanied by mild gait disturbance. Tremor frequency may decrease as the person ages, but the severity may increase, affecting the person's ability to perform certain tasks or activities of daily living.  Heightened emotion, stress, fever, physical exhaustion, or low [[blood sugar]] may trigger tremors or increase their severity.  Onset is most common after age 40, although symptoms can appear at any age.  It may occur in more than one family member. Children of a parent who has essential tremor have a 50 percent chance of inheriting the condition. Essential tremor is not associated with any known pathology. Its frequency is between 4 and 8&nbsp;Hz.<ref name=":0" />
* '''[[Orthostatic]] tremor''' is characterized by fast (>12&nbsp;Hz) rhythmic muscle contractions that occur in the legs and trunk immediately after standing up. Cramps are felt in the thighs and legs and the patient may shake uncontrollably when asked to stand in one spot.  No other clinical signs or symptoms are present and the shaking ceases when the patient sits or is lifted off the ground. The high frequency of the tremor often makes the tremor look like rippling of leg muscles while standing. Orthostatic tremor may also occur in patients who have essential tremor, and there might be an overlap between these categories of tremor.
* '''[[Parkinsonian]] tremor''' is caused by damage to structures within the brain that control movement. This resting tremor, which can occur as an isolated symptom or be seen in other disorders, is often a precursor to [[Parkinson's disease]] (more than 25 percent of patients with Parkinson's disease have an associated action tremor). A classic symptom is a characteristic fine tremor in the hands, which is traditionally described as a "'''pill-rolling'''" action of the hands,<ref>{{Cite book |last=Blows |first=William T. |url=https://books.google.com/books?id=sSHcEAAAQBAJ&q=pg%3DPT427 |title=The Biological Basis of Clinical Observations |date=2023-12-05 |publisher=Taylor & Francis |isbn=978-1-003-80609-7 |language=en |quote=This fine tremor has been called ''pill-rolling'', since this is the action taken during the manual production of pills before mechanisation and quality control.}}</ref> but Parkinsonian tremor may also affect the arms, chin, lips, legs, and trunk, and can be markedly increased by stress or emotion. Onset is generally after age 60. Movement starts in one limb or on one side of the body and usually progresses to include the other side. The tremor's frequency is between 4 and 6&nbsp;Hz.<ref name=":0" />
* '''[[Physiological tremor]]''' occurs in every normal individual and has no clinical significance. It is rarely visible and may be heightened by strong emotion (such as anxiety<ref name="GorollMulley2009">{{cite book|author1=Allan H. Goroll|author2=Albert G. Mulley|title=Primary care medicine: office evaluation and management of the adult patient|url=https://books.google.com/books?id=bIZvJPcSEXMC&pg=PA1178|access-date=30 May 2011|date=1 January 2009|publisher=Lippincott Williams & Wilkins| isbn = 978-0-7817-7513-7 |page=1178}}</ref> or fear), physical exhaustion, [[hypoglycemia]], [[hyperthyroidism]], heavy metal poisoning, stimulants, alcohol withdrawal or [[fever]]. It can be seen in all voluntary muscle groups and can be detected by extending the arms and placing a piece of paper on top of the hands. Enhanced physiological tremor is a strengthening of physiological tremor to more visible levels. It is generally not caused by a neurological disease but by reaction to certain drugs, [[alcohol withdrawal]], or medical conditions including an overactive thyroid and hypoglycemia. It is usually reversible once the cause is corrected. This tremor classically has a frequency of about 10&nbsp;Hz.<ref>{{Cite journal |year=1956 |title=Physiological tremor |journal=J. Neurol. Neurosurg. Psychiatry |volume=19 |issue=4 |pages=260–7 |doi=10.1136/jnnp.19.4.260 |pmc=497216 |pmid=13377192|last1=Marshall |first1=J. |last2=Walsh |first2=E. G. }}</ref>
* '''[[wikt:psychogenic|Psychogenic]] tremor''' (also called '''hysterical tremor''' and '''functional tremor''') can occur at rest or during postural or kinetic movement. The characteristics of this kind of tremor may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction or body part affected, and greatly decreased or disappearing tremor activity when the patient is distracted. Many patients with psychogenic tremor have a [[conversion disorder]] (see [[Post traumatic stress disorder]]) or another psychiatric disease.
* '''[[Rubrospinal tract|Rubral]] tremor''' is characterized by coarse slow tremor which is present at rest, at posture and with intention. This tremor is associated with conditions which affect the [[red nucleus]] in the midbrain, classically unusual strokes.
* Neuropathic '''tremor''' may occur in patients with [[Peripheral neuropathy|peripheral neuropathies]], when the nerves that supply the body's muscles are traumatized by injury, disease, abnormality in the central nervous system, or as the result of systemic illnesses. It is most commonly observed in patients with an immunoglobulin M paraproteinaemic neuropathy (IgMNP), but also in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). The tremor is predominantly exhibited as an action or postural tremor with a frequency of 3 to 10&nbsp;Hz.<ref>{{Cite journal |last1=Saifee |first1=Tabish Aziz |last2=Schwingenschuh |first2=Petra |last3=Reilly |first3=Mary M |last4=Lunn |first4=Michael P T |last5=Katschnig |first5=Petra |last6=Kassavetis |first6=Panagiotis |last7=Pareés |first7=Isabel |last8=Manji |first8=Hadi |last9=Bhatia |first9=Kailash |last10=Rothwell |first10=John C |last11=Edwards |first11=Mark J |date=November 2013 |title=Tremor in inflammatory neuropathies |url=https://jnnp.bmj.com/lookup/doi/10.1136/jnnp-2012-303013 |journal=Journal of Neurology, Neurosurgery & Psychiatry |language=en |volume=84 |issue=11 |pages=1282–1287 |doi=10.1136/jnnp-2012-303013 |pmid=22952325 |s2cid=15834975 |issn=0022-3050|url-access=subscription }}</ref> Peripheral neuropathy can affect the whole body or certain areas, such as the hands, and may be progressive. Resulting sensory loss may be seen as a tremor or ataxia (inability to coordinate voluntary muscle movement) of the affected limbs and problems with gait and balance. Clinical characteristics may be similar to those seen in patients with essential tremor.
* '''[[Neurogenic tremor]]''' is a self-induced tremor that is activated in humans. The mechanism is activated passive [[supine]] position, bringing the knees up and splitting them apart. The tremor is akin to the natural shaking mechanism in mammals to discharge stress and trauma.<ref>{{Cite book |last=Berceli |first=David |title=Shake it off naturally |publisher=CreateSpace |year=2015 |isbn=9781515065289 |edition=1 |pages=34–48 |language=English}}</ref> The type of tremor is also known as "self-induced therapeutic tremor".<ref>{{cite journal |last1=Berceli |first1=D |last2=Salmon |first2=M |last3=Bonifas |first3=R |last4=Ndefo |first4=N |title=Effects of Self-induced Unclassified Therapeutic Tremors on Quality of Life Among Non-professional Caregivers: A Pilot Study. |journal=Global Advances in Health and Medicine |date=September 2014 |volume=3 |issue=5 |pages=45–8 |doi=10.7453/gahmj.2014.032 |pmid=25568824|pmc=4268601 }}</ref> It is considered a kind of "spontaneous movement".<ref>{{cite journal |last1=Begin |first1=J |last2=Bertolucci |first2=LF |last3=Blostein |first3=D |last4=Minasny |first4=B |title=Characterizing a Common Class of Spontaneous Movements. |journal=International Journal of Therapeutic Massage & Bodywork |date=September 2022 |volume=15 |issue=3 |pages=4–17 |doi=10.3822/ijtmb.v15i3.719 |pmid=36061228|pmc=9401082 }}</ref>

Tremor can result from other conditions as well
* '''[[Alcoholism]]''', excessive alcohol consumption, or [[alcohol withdrawal]] can kill certain nerve cells, resulting in a tremor known as [[asterixis]]. Conversely, small amounts of alcohol may help to decrease familial and essential tremor, but the mechanism behind it is unknown. Alcohol potentiates [[gamma-Aminobutyric acid|GABAergic]] transmission and might act at the level of the [[Inferior olivary nucleus|inferior olive]].
* '''Tobacco withdrawal''' symptoms include tremor.
* Most of the symptoms can also occur randomly when '''[[Panic|panicked]]'''.