#Breeze Plan ##清风医生说 #
Image from the web
Uncle Quan was a middle school principal, 73 years old, less than 40 years old began to appear involuntary shaking of the left hand, more in the holding of things, or raise the hand / raise the hand is more obvious, the hand is still and relaxed when there is almost nothing unusual, he also found an interesting phenomenon, that is, the symptoms of hand shaking after drinking will be alleviated. Because of the image problem, he began to seek medical treatment very early, several hospitals in Xuzhou city have seen it, and the doctors have given him the same conclusion through examination, that is, idiopathic tremor, and told him that this disease is a "benign disease", generally there will not be too much of a problem, although the symptoms will gradually worsen, but the development is very slow, treatment, you can use drugs, but if the symptoms are mild, you don't have to care about it. Uncle Quan, who could not let go of his heart, still decided to seek a more authoritative diagnosis in a larger hospital, and the final conclusion was the same. After nearly 40 years, although the symptoms of hand shaking have been slowly aggravated (the left hand shake becomes a hand shake, the degree of getting worse is also slowly aggravated), but life is still able to get by, and in the past 1 year the symptoms worsened faster, and Uncle Quan's action has become more and more sluggish, always feel weak around, in addition to hand shaking, but also feel stiff, the so-called long-term illness into medicine, coupled with the teacher born to love to read, he worried that he had "Parkinson's disease", and then came to the hospital for treatment, this time the doctor diagnosed it Parkinson's disease diagnosis. That is to say, Uncle Quan has gradually developed from idiopathic tremor decades ago to Parkinson's disease, and what is the difference and connection between these two diseases that will "shake"?
We can often see some people shaking their hands involuntarily, perhaps you yourself have had or are experiencing this symptom, some places call this symptom "shivering", "hissing" or "hersing", medically called tremor. Tremor refers to an involuntary, rhythmic, oscillatory movement of a certain part of the body (which can be a hand, a leg, a head, or other part). That is to say, this jitter cannot be controlled by itself, and the frequency and amplitude of jitter are regular.
This has to start from the movement structure of our body, because our somatic motor system often has muscle settings in the opposite direction of movement, for example, our fingers can flex and straighten, under normal circumstances, when the fingers are flexed, the muscles responsible for straightening will relax and be stretched, on the contrary, when the fingers need to be straightened, the muscles responsible for flexion will relax, and under the regulation of the nervous system such as the brain and spinal cord, we will move freely. It's like a car, where there's a forward gear, there's a reverse gear. If there is a problem with the control system, forward gear, reverse gear at the same time, the car will drive forward or backward? It's not driving, it's a "tug-of-war", in which the strength of the two cannot always be exactly the same but evenly matched, so there will be a swinging movement back and forth, and if this frequency is fast, it is a tremor.
You can do a small experiment on your own, fold your hands together, push your hands forward together, and soon you will find that your hands are shaking involuntarily, and in the same way, the hands can be pulled out with the corresponding situation, which is the "tremor" produced in the case of muscle confrontation.
Normal people themselves also have a very low amplitude, high frequency (about 10-12 Hz) tremor, known as physiological tremor. Mainly relative to "pathological". In general, it is usually not visible or felt by themselves, and a small number of normal people will show mild physiological tremors, but this does not affect daily activities, and there are a variety of factors that can enhance this physiological tremor (the most common factor is increased sympathetic activity). Tremors occur in situations such as anxiety, excitement, nervousness and fear, muscle fatigue, hypoglycemia, alcohol and opioid withdrawal, hyperthyroidism, fever, etc. Other drugs such as theophylline, caffeine, some antidepressants, etc. may also strengthen the physiological tremor through the influence of neuromodulation, resulting in involuntary shaking of our bodies, but for the sensitivity of these factors, everyone is different, which explains why some people will shake their hands after drinking coffee, while most people will not.
Speaking of the disease that causes involuntary hand shaking, I believe that the most well-known is Parkinson's disease, especially after the opening ceremony of the 1996 Atlanta Olympic Games in the United States, when the former boxing king Ali held a torch to light the flame in an extremely uncoordinated manner after the camera was broadcast around the world, the popularity of this disease also rose, since then everyone has an impression that there is a disease called Parkinson's can cause hand shaking. Many patients also come to the door and ask: "Doctor, my hands are always shaking, isn't it Parkinson's?" "As everyone knows, in addition to Parkinson's, there are many cases of hand shaking, even as a disease, Parkinson's disease is not the most common condition that causes hand shaking.
Idiopathic tremor, the most common disorder that causes tremor, is estimated to be as prevalent as high as 5% worldwide, meaning that 1 in 20 people has the condition. Some patients with idiopathic tremor have a family history, such as Uncle Kwon, who had a shaky hand when his father was alive, and his son also had symptoms of hand shaking in his forties. Therefore, when there is a family history, this type of disease is also called familial tremor. In the past, doctors often used "benign tremor" to distinguish this disease from Parkinson's disease, because the past view was that unlike Parkinson's disease, idiopathic tremors did not have a serious impact on life ability and did not lead to shortening of life, but it was later found that some patients with idiopathic tremors can also be very serious, resulting in a significant decline in life ability.
In addition, unlike Parkinson's disease, for idiopathic tremor, the specific causes and pathogenesis are still poorly known, but it is known that there is a certain familial heredity of the disease, it is speculated that it is related to genetic mutations, and it is pathologically speculated that it is related to brainstem (blue plaque nucleus) and cerebellar lesions. Because of this, it has a "idiopathic" hat before its name. That is to say, for example, a considerable number of hypertension diseases will be preceded by a prefix of "primary hypertension", in fact, the reason is very simple, that is, at the current level of medicine, it is impossible to explain the exact cause of these diseases, and doctors add a prefix in order to distinguish from those diseases with clear causes. For example, some hypertension is caused by pregnancy or adrenal gland diseases, etc., this hypertension is collectively referred to as "secondary hypertension", I believe that with the continuous development of medicine, "idiopathic" and "primary" will gradually be replaced by "secondary".
Hands shaking. The most common symptom of idiopathic tremor is involuntary shaking of the hand and forearm, which can be either on one side or both sides, and symptoms on one side can gradually turn into bilateral. The symptoms of hand shaking are generally obvious when holding something or raising an arm, and the body movement is most shaking when it is about to end, such as picking vegetables or drinking water, when the whole action is about to end, that is, when it is sent to the mouth to eat/drink, the shaking is severe, and the severe patient cannot eat or drink on his own, which is the so-called "postural/action tremor". This is different from Parkinson's disease, first, Parkinson's disease does not necessarily have limb shaking, and secondly, Parkinson's disease limb shaking, most obvious when stationary, that is, "resting tremor".
Head shaking. Idiopathic tremor may present with involuntary noding or shaking of the head, i.e., head tremor, often accompanied by a tremor of the voice as it speaks. However, it usually does not appear only as a head symptom, but usually with one or both hands.
Symptoms improve after drinking alcohol. Idiopathic tremor has an interesting symptom, that is, after drinking to improve, many patients with drinking habits, when they just drank, there is still some instability in taking the wine glass, a few glasses of wine under the stomach, the symptoms are significantly alleviated.
Symptoms that do not usually occur with idiopathic tremor:
Legs shaking. Idiopathic tremors rarely affect the lower extremities, especially when the legs are resting, and Parkinson's disease needs to be considered.
Slow to act. Unlike Parkinson's disease, idiopathic tremor often does not cause the patient to move slowly/sluggishly, especially when walking, it will have no effect, and generally does not cause the patient to "small steps", "forward rush" and other Parkinson's-like symptoms.
Limbs are weak and stiff. Because idiopathic tremor generally does not affect the increase in muscle tone, patients generally do not experience stiffness and inactivity of the limbs.
Symptoms worsen after drinking coffee. Unlike the physiological tremor mentioned above, patients with idiopathic tremor tend not to worsen their symptoms after coffee.
Possibly.
More and more studies suggest that idiopathic tremors can lead to an increased risk of Parkinson's disease, and some experts even believe that patients with idiopathic tremors, as long as they live long enough, will eventually develop Parkinson's disease. However, clinically, although the symptoms of idiopathic tremor patients progress slowly, the majority of people who do not progress to Parkinson's disease for years or even decades are still the majority. Therefore, it is believed that idiopathic tremor may reduce the quality of life, but does not affect the natural lifespan.
No treatment is required. For many early patients with idiopathic tremor, that is, although there is a little hand shaking and other symptoms, but basically do not affect life, so in this case, doctors often do not recommend the use of drugs, because drugs only alleviate symptoms, it is currently believed that drugs can neither cure the disease, and can not delay the further development of the disease, only "cure the symptoms" rather than "cure the root cause", so in the case of not affecting life, pay attention to observation.
drug therapy. When the symptoms of jitter are more obvious, causing a significant decline in quality of life, the doctor may prescribe drugs for you, there are more types of drugs, and the dosage is also exquisite, but there is no specific drug for this disease. When you get your medications, you may find them to treat heart disease, epilepsy, insomnia and other conditions. Don't misunderstand that the doctor prescribes the wrong drugs, which are often effective for idiopathic tremor in addition to treating the above diseases. However, it is precisely because of the particularity and non-specificity of the drug, doctors tend to be more cautious when using drugs, and medication and drug discontinuation have certain rules, so patients with idiopathic tremor should not use drugs privately, let alone eat and stop, when to take drugs, listen to doctors, how to reduce stops, and need to consult doctors.
Surgical treatment. If the symptoms of idiopathic tremor are severe and the results of several different types of medication are not satisfactory, surgery may also be considered. This requires a professional doctor to help the patient judge.
As for the prevention of idiopathic tremor, because the cause of the disease is not clear at present, it is not effective to prevent it. It can only be said that when your family has idiopathic tremor, or even Parkinson's disease, you need to know that this disease has a certain family genetic predisposition, you need to pay attention to your own symptoms, but do not worry too much, not to say that the elders have, you yourself will have, not to say that your children will be "passed on from generation to generation" and so on. It is just that the chance of onset is greater than that of the average person.
Key References: 1.benito-león j, louis ed, bermejo-pareja f, neurological disorders in central spain study group. risk of incident parkinson's disease and parkinsonism in essential tremor: a population based study. j neurol neurosurg psychiatry 2009; 80:423. 2.louis ed. environmental epidemiology of essential tremor. neuroepidemiology 2008; 31:139. 3.louis ed. essential tremors: a family of neurodegenerative disorders? arch neurol 2009; 66:1202. 4.louis ed, dogu o. isolated head tremor: part of the clinical spectrum of essential tremor? data from population-based and clinic-based case samples. mov disord 2009; 24:2281. 5.zesiewicz ta, elble r, louis ed, et al. practice parameter: therapies for essential tremor: report of the quality standards subcommittee of the american academy of neurology. neurology 2005; 64:2008.