Re: Seek info re internal tremor

[Bob Chapman <rchapman99@xxxxxxxxxxxxx>]

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
> judithr@xxxxxxxx
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