I, too, experienced internal tremors, but my neurologist attributed them to
anxiety. The following article was posted to the list in January of 1996 by
Alan Bonander.
Judith Richards
Date: Mon, 15 Aug 1994 08:40:36 EDT
Sender: Parkinson's Disease - Information Exchange Network
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From: [log in to unmask]
Subject: Internal tremor
This is an article that appeared recently in the Parkinson Report:
Unusual Symptoms in Parkinson's Disease
By Lisa M. Shulman, MD, Clinical Research Fellow
William J. Weiner, MD, Director, Movement Disorders Center,
University of Miami School of Medicine
A National Parkinson Foundation Center of Excellence
PARKINSON REPORT, National Parkinson Foundation Inc., Vol. XV, Issue II, 2nd
Quarter, 1994.
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.
END
Regards,
Alan
