Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Tremors?
Question: HELLO,I HAVE BEEN TAKING 400 MG/D OF LAMOTRAGINE FOR BP TX FOR APPROX. 10 YRS. AS A MONOTHERAPY(HAVE REFUSED POLY PROTOCOLS). I 'VE NOTICED A HAND TREMOR SLOWLY WORSENING IN THE PAST YR. OR TWO.MY MOTHER HAD PARKINSON'S ;HOWEVER, A NEUROLOGIST(SEEN SHORTLY AFTER STARTING LAMICTAL DUE TO A SLIGHT HAND TREMOR). HE STATED HE WAS 99% SURE I DID NOT HAVE THAT DX AS I HAD NO RESTING TREMORS.I NOW HAVE GREAT TROUBLE WRITING& FREQUENT FALLS WHICH MAY BE ATTRIBUTABLE TO A SHUFFLING GAIT.I AM A 68 Y. O. MALE&CORRECTLY DX'D AS A TEEN . I WAS ORIGINALLY PLACED ON THE OLD STANDARD, LITHIUM, WHICH I TOOK FOR APPRX. 20 YRS. I RECENTLY PRESSURED MY PSYCHIATRIST TO LOWER MY DOSEAGE TO 300 MG/D DUE TO THESE PROBLEMS;HOWEVER, I'M HAVING AN INCREASED # & SEVERITY OF DEPRESSIVE EPISODES (NO SUICIDAL IDEATION)& NOTICEABLE MANIC EPISODES(NOT PREVIOUSLY NOTICEABLE AT 400 MG/D) . I LIVE IN A RATHER SM. AREA OF APPROX. 1000,000 C 3 PSYCHS&CONSIDER MINE A BRILLIANT PSYCHOPHARMACOLOGIST C THE BEDSIDE MANNER OF A LIZARD&WHO DOES NOT APPRECIATE PATIENT INPUT . I AM AWARE I AM ON A VERY LOW DOSEAGE PROTOCOL. RECENTLY,A FRIEND NOTICED I WAS HAVING AN UNUSUAL # OF RESPIRATIONS C NO EXERTION.I HAVE A SLIGHT MITRAL VALVE PROLAPSE WHICH HAS NEVER CAUSED A PROBLE C MY ADL'S. IS IT POSSIBLE THESE SYMPTOMS COULD BE CAUSED BY MY LOW DOSE OF THIS DRUG?
Brief Answer:
Observe for the kay features of parkinson's.Tremors can be drug induced.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through your detailed medical history. If you would have presented to me as an outpatient, I would have considered drugs as the possible cause of those tremors. Both the drugs you are taking - Lamictal and Lithium could be the possible cause of your tremors. However,Tremors have increased over past year or so, even as you have reduced the dose of Lithium which makes Lithium as the less possible cause.
In this context, we can consider checking serum lamotrigine levels. This tests will give us a fair idea on how to handle lamictal. Moreover,you can discuss with the treating doctor if he wish to substitute Lamictal with some other drug.
On second thoughts, as the tremors have increased in severity over past one or two years, Parkinson's can be considered if the following key points are also observed-
1)Whether tremors started in both hands simultaneously or asymmetrically (like initially in left and then right or vice versa). Asymmetric onset of tremors is classical of Parkinson's disease.
2)Your neurologist rightly said that tremors are mostly rest tremors in parkinson's disease. Sometimes we also see postural tremors with parkinson's. However, action tremors are unlikely with it. So, please observe for the tremors-whether postural or rest tremors.
3)Bradykinesia-slowness of daily activities is one of the key features of parkinson's disease. Please observe for the same.
4)Rigidity-tightness of limbs is also a key feature. Do you have it?
I did not find those key features in your description. But please look for those closely and if you find them, you should press for parkinson's evaluation.
Lastly, if tremors are symmetrical, essential tremors which are very common at your age should also be considered. Here a trial of beta-blockers is must in case of symmetrical tremors.
Not to forget,that anxiety and thyroid dysfunction are the commonest causes of tremors. So,please get 'Thyroid function tests' done and start doing mental relaxation exercises like meditation.
Hope that I have answered your query for now.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Observe for the kay features of parkinson's.Tremors can be drug induced.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through your detailed medical history. If you would have presented to me as an outpatient, I would have considered drugs as the possible cause of those tremors. Both the drugs you are taking - Lamictal and Lithium could be the possible cause of your tremors. However,Tremors have increased over past year or so, even as you have reduced the dose of Lithium which makes Lithium as the less possible cause.
In this context, we can consider checking serum lamotrigine levels. This tests will give us a fair idea on how to handle lamictal. Moreover,you can discuss with the treating doctor if he wish to substitute Lamictal with some other drug.
On second thoughts, as the tremors have increased in severity over past one or two years, Parkinson's can be considered if the following key points are also observed-
1)Whether tremors started in both hands simultaneously or asymmetrically (like initially in left and then right or vice versa). Asymmetric onset of tremors is classical of Parkinson's disease.
2)Your neurologist rightly said that tremors are mostly rest tremors in parkinson's disease. Sometimes we also see postural tremors with parkinson's. However, action tremors are unlikely with it. So, please observe for the tremors-whether postural or rest tremors.
3)Bradykinesia-slowness of daily activities is one of the key features of parkinson's disease. Please observe for the same.
4)Rigidity-tightness of limbs is also a key feature. Do you have it?
I did not find those key features in your description. But please look for those closely and if you find them, you should press for parkinson's evaluation.
Lastly, if tremors are symmetrical, essential tremors which are very common at your age should also be considered. Here a trial of beta-blockers is must in case of symmetrical tremors.
Not to forget,that anxiety and thyroid dysfunction are the commonest causes of tremors. So,please get 'Thyroid function tests' done and start doing mental relaxation exercises like meditation.
Hope that I have answered your query for now.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
