Tremulousness is shaking, commonly caused by neurological problems, stress, or medications. Some patients may experience isolated and intermittent tremors, while others may develop whole-body tremulousness. A careful evaluation is necessary to find out why the patient is shaking and determine the best course of action for managing the problem. It is usually a symptom of an underlying medical issue and controlling the cause may resolve or reduce the shaking.
Some patients experience tremulousness in response to trying to complete a specific task, like walking, while others shake at random. The shaking may make it hard to walk, eat, or speak, because it interferes with normal function. Older adults tend to be more prone, although it can onset in young patients as well.
One reason to develop tremulousness is a neurological problem which may be caused by disease or injury; brain damage and Parkinson’s disease, for example, can both cause shaking. Injuries to the brain can be hard to treat but medications may help control the shaking. Patients can also consider physical therapy to help them regain muscle control and learn to perform tasks even when they are shaky. Speech-language pathologists can help people learn to eat and speak despite tremors.
Stress, anxiety, and certain psychological disorders can also cause tremulousness, as can trauma. Someone who has just been in a severe car accident, for example, may shake uncontrollably with fear, relief, and other emotions. Post-traumatic stress disorder can be associated with tremulousness in some patients, who may experience shaking in connection with flashbacks. People having panic attacks may also experience this symptom.
Medications have been known to cause shaking and tremors as well, and may be fingered as the culprit in a patient interview to learn more about when and how the symptom first developed. The shaking may resolve if the medication is stopped, or it may persist, sometimes lasting for life, in the case of certain psychiatric medications. This is a known risk of some antipsychotics, for example, and an important consideration in prescribing practices.
Sometimes myoclonus, involuntary muscle twitching, is mistaken for tremulousness. In these patients, the jerking of random muscles can create the appearance of shivering or shaking. Testing can show that the problem is caused by misfiring muscles, not neurological problems or reactions to psychological stress. Accurate diagnosis with brain imaging and muscle testing is important, because it may have an impact on the most appropriate treatment for the patient; someone with myoclonus, for example, doesn’t need drugs used to treat Parkinson's related tremors.
