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This is an excellent article on "internal tremor". Thanks for your posting it to this list. I often wonder just what is "internal tremor" ? It looks like we really just don't know. Bob Chapman Judith Richards wrote: > Tom wrote: > >Several folk have mentioned experiencing the dreaded internal > tremor,...My neuro,...seems puzzled about it.I would be deeply grateful > for any info at all about this blight on sleep. > > UNUSUAL SYMPTOMS IN PARKINSON’S DISEASE > (posted to PIEN, August 1994) > > By Lisa M. Shulman, MD, Clinical Research Fellow, > and William J. Weiner, MD, Director, > Movement Disorders Center, University of Miami School of Medicine. > > Do you ever feel a tremor inside your body that cannot be seen by > others? > Forty-four (44) percent of patients with Parkinson's disease said "yes" > in a recent study conducted at the U. of Miami School of Medicine, > Department of Neurology, Movement Disorders Center. This "internal > tremor" is experienced in either the extremities, chest or abdomen. > Commonly, it is reported on the same side as the other > parkinsonian symptoms, such as the typical observable tremor. Internal > tremor generally occurs in brief episodes lasting less than half an hour > and with a frequency of several times per week. Eighty (80) percent of > patients describe this as unpleasant, uncomfortable or painful. > The sensation of internal tremor is the most recent example of a number > of sensory symptoms that have gained increasing recognition in > Parkinson's disease. A variety of sensory phenomena such as aching, > burning, tingling and numbness have been previously studied. > Approximately 40% of patients report these sensations. Similar to > our findings in internal tremor, these other sensory symptoms occur > intermittently and often correspond in location to the side of the body > more affected by Parkinson's disease. > Internal tremor and other sensory symptoms of Parkinson's disease are > not simply a curiosity; they are a significant source of difficulty and > disability for many patients. > Sensory symptoms may appear early in the course of illness, perhaps > prior to the motor symptoms. Both patients and physicians are less > familiar with the sensory manifestations of Parkinson's disease, > impeding accurate and early diagnosis. Sensory symptoms are often not > mentioned in descriptions of parkinsonism. This may be a source of > bewilderment and concern to both patients and family members. > Additionally, both internal tremor and other Parkinson's related > sensations may be uncomfortable and of sufficient intensity to merit > specific treatment. > While sensory symptoms may be of special, or even predominant concern > to the patient, they pose a unique dilemma to the physician. The doctor > must rely totally on the historical accuracy and insights of the > patient. Unlike the assessment of motor symptoms, such as the > observable resting tremor, rigidity, slowing of movement or difficulty > walking, sensory symptoms cannot be observed or objectively evaluated by > the physician. Identification and management will be optimized by > precise reporting of the timing, frequency, location and severity of > symptoms. Information regarding factors associated with both the > exacerbation and relief of unusual sensation can also be helpful. > Interestingly, when patients with and without internal tremor are > compared, there is no difference in the duration or severity of their > Parkinson's disease symptoms. There also is no observable tremor > alone. The patients with internal tremor are far more likely > to experience other sensory symptoms (aching, tingling, burning, > numbness) than their counterparts without internal tremor. > > What is the cause of internal tremor? > The answer to this question remains unclear, but we can speculate that > it may represent a very mild tremor that is too subtle to be detected by > observation. If this is true, it is indeed surprising that there was no > discrepancy in the presence or severity of > resting tremor. More than 80 percent of patients with Parkinson's > disease have an observable resting tremor. > Alternatively, the sensation of internal tremor may have more in common > with the other Parkinson's related sensory symptoms. The parts of the > brain that are affected by the changes of Parkinson's disease may play a > role in the interpretation of sensory information. Misinformation in > the form of unusual sensory phenomena may be the > result. In certain patients readjustment of the medications used in the > treatment of their motor symptoms can relieve the sensory symptoms as > well. > Although it is important for both patients and physicians to be aware > of the existence of Parkinson's related sensory symptoms, one must be > wary of developing an overly casual attitude to reports of unusual > sensations. When symptoms suggest other possible causes, appropriate > evaluation should be pursued to exclude these alternatives. > The potential causes of recurring sensory symptoms are numerous, and > need to be approached on an individual basis. > While our knowledge of these symptoms remains incomplete, awareness of > the widespread nature of this problem can be reassuring. Further > studies of the sensation of internal tremor are currently planned at the > U. of Miami to aid in both better understanding and treatment of this > previously undescribed symptom in Parkinson's > disease. > > -- > Judith Richards, London, Ontario, Canada > [log in to unmask] > Today’s Research... > Tomorrow’s Cure