What Causes Mild To Severe Trembling?

Brief Answer:
explained about tremors.

Detailed Answer:
Hello and welcome

I appreciate your concern

What you are describing , seems to be tremors.
Tremor is an involuntary shaking movement that is repeated over and over. Although it may affect any part of the body, tremor most often affects the hands and head. Your voice may also shake. Sometimes the feet or torso may also shake.

Tremors can also be caused by conditions or medicines that affect the nervous system, including Parkinson's disease, liver failure, alcoholism, mercury or arsenic poisoning, lithium, and certain antidepressants. Side effects from other medicines can also cause tremors

If you notice a tremor, observe it carefully and note what seems to make it better or worse before calling your doctor. There are some differences between essential tremor and tremor caused by Parkinson's disease. If a cause is discovered, the disease will be treated rather than the tremor

In general, essential tremor is considered to be mono symptomatic (tremor only). Although some patients have abnormalities in gait and balance, most do not; therefore, carefully consider alternative diagnoses in the presence of gait abnormalities.

Patients with essential tremor may exhibit the following signs and symptoms:

•Tremor begins in one upper extremity and then affects the other upper extremity; tremor rarely extends from an upper extremity to the ipsilateral lower extremity


•Tremor may initially be intermittent, occurring during periods of emotional activation, and then becomes persistent over time


•A mild degree of tremor asymmetry is not unusual


•Tremor may also affect the head, voice, jaw, lips, and face


•The tremor frequency is fixed at any point in time


•The tremor amplitude is highly variable, worsened by emotion, hunger, fatigue, temperature extremes; the baseline amplitude gradually increases over several years; ethanol intake temporarily reduces tremor amplitude in about 50-70% of cases


•Typically, there is a degree of voluntary control; tremor may be suppressed by performing skilled manual tasks

•Tremor resolves when the body part relaxes as well as during sleep


Electromyography or accelerometry can be used to assess tremor frequency, rhythmicity, and amplitude though not routinely required

No biologic markers exist for essential tremor. If the family history and examination findings are indicative of essential tremor, no laboratory or imaging studies are required. However, if the family history and examination findings are not indicative of essential tremor, laboratory and imaging studies should be considered.[41, 42]

Laboratory investigations include the following:

•Standard electrolyte panel
•Thyroid function tests
•Blood urea nitrogen (BUN)
•Creatinine
•Liver function tests
•Serum ceruloplasmin (for XXXXXXX disease)

Parkinson could be a cause. Parkinson disease is a clinical diagnosis. No laboratory biomarkers exist for the condition, and findings on routine magnetic resonance imaging (MRI) and computed tomography (CT) scan are unremarkable. Positron emission tomography (PET) and single-photon emission CT (SPECT) may show findings consistent with Parkinson disease, and olfactory testing may provide evidence pointing toward Parkinson disease, but these studies are not routinely needed.

No laboratory or imaging study is required in patients with a typical presentation. Such patients are aged 55 years or older and have a slowly progressive and asymmetric parkinsonism with resting tremor and bradykinesia or rigidity. Patients who do not have tremor should generally be considered for MRI evaluation to exclude brain lesions such as stroke, tumor, or demyelination.

In patients with an unusual presentation, diagnostic testing may be indicated to exclude other disorders in the differential diagnosis. Such tests may include serum ceruloplasmin, sphincter electromyography, or lumbar puncture.

Serum ceruloplasmin concentration is obtained as a screening test for XXXXXXX disease in patients younger than 40 years who present with parkinsonian signs. If the ceruloplasmin level is low, measurement of 24-hour urinary copper excretion and slit-lamp examination for Kayser-Fleischer rings must be performed. Abnormal results on urinary sphincter electromyography have been noted in patients with multiple system atrophy (MSA).

A substantial and sustained response to dopamine medications (dopamine agonists or levodopa) helps confirm a diagnosis of Parkinson disease. It is unclear whether acute levodopa or apomorphine challenge has any advantage over clinical diagnostic criteria.[20] Over time, diagnostic accuracy improves as the progression of signs and symptoms and response to medications unfolds.

In the general community, there is a high diagnosis error rate between Parkinson disease and essential tremor. For movement disorder neurologists, when an erroneous diagnosis of Parkinson disease is made, the most likely correct diagnoses are the atypical parkinsonisms (MSA, progressive supranuclear palsy [PSP], corticobasal ganglionic degeneration [CBD]). Early in the disease course, it may be very difficult to distinguish between Parkinson disease and the atypical parkinsonisms. These disorders also do not have laboratory biomarkers, and, therefore, distinguishing among them is based on clinical criteria. Olfactory testing may help differentiate Parkinson disease from PSP and CBD, but olfaction is also reduced in MSA.


So, I would advise a neurological exam by a doctor to assess the need for Imaging like CT or MRI in case there is a neurological deficit or other indication that is relevant.

Do not stop the medications abruptly, though the medications especially the anti depressants can be weaned of to see for improvement.

I would also suggest you consult a psychiatrist
so that a XXXXXXX mental state exam is performed.
to ascertain depression and or anxiety,
Medication can be adjusted afterwards in addition
to cognitive behavioral therapy

Let me know if you have any query
thanks

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