My hands tremble. Do I have Parkinson’s? Not necessarily. There are other possible causes as well. A neurological examination is recommended if a person is experiencing an irritating trembling (tremor) in the hands, legs or face. It can be difficult to identify Parkinson’s disease, because it has a creeping onset. A diagnosis is based on the clinical symptoms and sometimes the additional examinations.

Warning symptoms

A person experiencing acute, unusual trembling or severe deterioration should see a doctor. Early signs of Parkinson’s disease vary greatly and are often not especially severe. Trembling (“bread-crumbling” tremors) when idle, changes in a person’s handwriting, diminished sense of smell, slowing movements, sleep disturbances, stiff muscles, constipation, etc. are possible signs of the onset of Parkinson’s disease.

What will the doctor want to know?

The doctor will ask the patient how their movement is limited in their everyday life, if they find themselves fumbling with tasks, have any gait disturbances and have had any recent falls. Have there been changes in their memory? Are there any other symptoms?

Common causes

The most common cause is what is known as an essential tremor, whereby there are no other symptoms of Parkinson’s disease. Essential tremors are typified by an often slow, but sometimes rapid progression of the disease. The hands, head, voice and legs are often affected. Only in very rare cases do essential tremors cause any appreciable impairment.

In many cases, there are only intense physiological tremors. Many people experience tremors in conjunction with stress and physical exertion. Various substances, such as coffee or stimulants and certain medications, can also cause trembling. Tremors caused by brain damage (stroke, tumor, accident) are referred to as symptomatic tremors.

Task-specific tremors, such as writer’s cramp or head shaking, can be treated with botulinum toxin.

Tremors are a side effect of certain medications.

Symptoms of Parkinson’s disease

Parkinson’s disease is a progressive degenerative disorder of the central nervous system and primarily (but not only) effects a person’s motor functions. Sufficient amounts of the neurotransmitter dopamine can no longer be produced. The telltale symptoms of Parkinson’s are

  • Stiffness
  • Trembling (“bread-crumbling” tremors: hand tremors pronounced in the fingers and that resemble bread crumbling or pill-rolling)
  • Slowing of movements
  • Small-step gait
  • Trouble balancing
  • Slowed speech, changes in handwriting, less pronounced facial expressions.

The neurological examination also identifies non-motor symptoms, such as diminished sense of smell or sleep disorders. Parkinson’s sufferers also frequently suffer from depression and have problems with blood pressure and digestion. Many patients attribute these changes to the aging process before they are ultimately diagnosed with Parkinson’s disease.

Depending on the individual situation, additional examinations (e.g. special brain imaging) will be required.

Treatment possibilities

Essential and physiological tremors respond very well to medications.

Should the person indeed be diagnosed with Parkinson’s, a range of drugs is available to treat the disease. Depending on the main symptom, the goal is to prepare a treatment plan and consult with other medical professionals. The doctor and patient will decide whether and when to begin treatment. If the progression of the disease is on the less acute end of the spectrum, a person can lead a more or less normal life well into the future with the help of motor exercises, physical therapy, and speech exercises.

In special cases, deep brain stimulation is another possible option.