Hello sir,

Thanks for posting this query in XXXXXXX
The approach to a patient with tremor begins with identification of the timing of tremor. Is it at rest or while doing routine duties or on specific task?

All these questions have important implications in treatment

The most common type of tremor that can be seen in normal individuals is physiologic tremors. These are low amplitude and high frequency (8-12 Hz) postural tremors or that is most prominent in outstretched hands. These are the tremors which are common in normal individuals and can be enhanced under certain circumstances like fever, alcohol withdrawal, coffee, excitement, anxiety.
I disagree that action tremor the way you have mentioned can be normal. So I advise you to get examined by another local neurologist or go to a centre having expert movement disorder experts. They will examine you and evaluate you.

Hope this helps
I will be happy to clarify further in this issue.

Dr Gopal K Dash
Neuologist

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Thanks for the follow up.

It is good that your neurologist has given you a clean XXXXXXX of health
Physiologic tremors are generally low amplitude and high frequency tremor. One can know that there is tremor but it will be difficult to count the exact frequency. There are special instruments which can count the exact frequency. Whereas tremor of Parkinson’s disease for example will be of relatively low frequency and high amplitude.

The presence of tremor only in specific task is unusual for physiologic tremor or tremor related to anxiety. The tremor which happens with a specific task only is called as primary task specific tremor like primary writing tremor.

Every day posture will not generally make the physiologic tremor noticeable. It is the out stretched hands that will make it more visible.

Hope this clarifies all your questions

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Hello sir,

Please find the response point by point as follows
I have responded each of your questions


Patient : Sorry to be a pain, I'm just trying to understand something.

Doctor: It’s ok

Patient : In your first answer you said about physiological tremors - "These are low amplitude and high frequency (8-12 Hz) postural tremors". I'm just trying to understand what kind of "postures" would make physiological tremors more noticeable.
Doctor : Physiological tremors can be more noticeable when the hands are outstretched, when some holds a glass, plate etc.

Patient : You referenced holding out one's arms as an example. I mentioned holding up a glass of water as something that no one could do without the water moving to some degree (I assume that is physiological tremor and normal).
Doctor : I agree and it may be compounded by anxiety too

Patient : I ask because there are times when my hands are in awkward positions, such as when I hover my index finger over my computer mouse (but do not rest on it), while holding the mouse with the rest of my hand, that I see a slight amount of movement in the finger tip, which might be within the bounds of what is physiological. I don't know if its usual to hold your finger up in the air without it moving, or if the strain is what would cause the movement.
Doctor : This may be physiological with aggravation related to anxiety, stress or thyroid problem

Patient : It's not noticeable to anyone else, without them having to come close and stare at it and like I said it only moves like a millimeter back and forth.
Doctor : I understand
Patient :So, I'm just trying to get a handle on what kind of postures are likely to put enough strain on a normal person that their finger or hand is bound to move.

Doctor:The postures which make these types of tremors may be outstretched hands, holding a glass of water, tea or even while typing the computer or the position you told

Patient :I hope that makes sense. The bottom line, is I don't expect most people's hands are as steady as robots. So I'm trying to gather if a very fine tremor is within the bounds of physiological or if there are some awkward postures that are bound to promote some kind of slight tremor. They do sell ergonomic keyboards and mice. I take it that is to avoid unnatural postures.

Doctor :Yes, a very fine tremor is within the bounds of physiological some awkward postures do aggravate physiological tremors in susceptible individuals

Patient :Apologies again for my long and convoluted question.
Doctor :Its fine.

Final comment by doctor : As your neurologist has given a clean XXXXXXX of health and I feel you have got your answer in detail, I hope we can close close this discussion.

Let me know in case of any further query.


Best wishes

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Hello sir,
Thanks for the feed back
Best wishes

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