Muscle tremor refers to the continuous and rhythmic contraction and relaxation of muscles at the frequency of 4-8 times per second, which is called muscle tremorcentral nervous systemA symptom of a disease.
Mainly due toSubstantia nigraAnd nigrostriatal pathway. Common diseases include encephalitiscraniocerebral injury 、Arteriosclerosis, basal ganglia tumor, and some chemicals poisoning, such as chronic poisoning of mercury and manganese, can show toxic effects of muscle tremor.Tremor can start from the distal end of one side of the upper limb, then spread to the lower limb on the same side and the upper limb on the opposite side, and finally involve the lips, tongue, jaw and head. Emotional excitement can aggravate the tremor and completely stop during sleep anesthesia.It is necessary to find out the cause of the disease and treat the primary disease.
classification
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Static tremor: Tremor occurs at rest, such as "pill rubbing".Intentional tremor seen in Parkinson's disease: occurs during movement, the closer the purpose is, the more obvious it is. It is seen in cerebellar lesions, andEssential tremorIt is also called familial and hereditary benign tremor.Flapping wing tremor: seen in the early stage of liver comaChronic liver disease。Senile tremor: nodding or shaking head, noMuscular tensionincrease.
pathogeny
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Physiological tremor In some cases, most normal people will experience slight rapid tremor when their upper limbs are stretched forward. The intensification of physiological tremor can be seen in anxiety, tension, fatigue, metabolic disorders (such as alcohol withdrawal, thyroid toxicity), or the use of certain drugs (such as caffeine and othersPhosphodiesterase inhibitor,β-Adrenergic agonists,Adrenocortical hormone).
A mild to coarse, slow tremor that usually affects the hands, head, and vocal cords. It occurs in 50 percent of casesAutosomeDominant genetic factors. Tremor can be unilateral. Tremor is very slight or does not occur when the patient is still. When the patient performs delicate movements, it can cause tremor. Under the influence of any of the above factors that can strengthen physiological tremorPrimary tremorThe incidence of primary tremor also increases with age, which is sometimes wrongly called senile tremor
Tremor of cerebellar diseasesIntentional tremor(as seen inMultiple sclerosisOther cerebellar efferent disorders) occur when the moving limbs are close to the target. Supportive (positional) tremor is a large rotational tremor at the proximal end of the limbs, which is most significant when the patient tries to maintain a fixed posture or load. Titulation is a large tremor of the head and body, which is also a supportive tremor. It is obvious when maintaining an upright posture, and disappears after lying flatFlapping wing tremorSee athepatic encephalopathyWith other metabolic encephalopathy cases, when the patient extends his hands forward, there will be a large, slow, non rhythmic movement. Using electromyography records, it can be observed that when the patient tries to maintain a fixed position, there will be intermittent electromyography rest in the anti gravity muscles, resulting in flapping wing like tremor;Therefore, it is not a real tremor, but a kind ofMyoclonusPhenomenon, a negative myoclonus
(1) Tremor part: usually starts from the distal end of one side of the upper limb, mainly the thumb, index finger and middle finger, and it is manifested as the movement of fingers like rubbing balls or counting money.Then it gradually extends to the ipsilateral lower limbs and the contralateral limbs, and can affect the mandible, lips, tongue and head in the late stage.In the early stage of the disease, patients do not care much about tremor, which often occurs when the fingers or limbs are in a special position, and disappears when the posture is changed.Later, it will only appear when the body is still. For example, when watching TV or talking with others, the body suddenly appears involuntary trembling, and the trembling is reduced or stopped when changing position or movement, so it is calledStatic tremorThis is the most important feature of Parkinson's disease tremor.Sometimes the lower limbs are also more obvious or the tremor of other parts is more prominent.Some patients with tremor appeared late, mainly rigidity, and were often misdiagnosed as hemiplegia.
(2) Tremor frequency: the tremor frequency of Parkinson's disease is mostly 4-8 times/second, which is generally slower and larger than simple tremor, but faster and smaller than action tremor.This feature can also help us distinguish other diseases, such as chorea, cerebellar diseases, andHyperthyroidismAnd other diseases.
(3) Tremor is volatile: sometimes obvious, sometimes reduced or disappeared.Nervous tension, emotional excitement and tremor at the beginning are obvious, and they are relieved when exercising at will, and disappear after sleep.
(4) Influence of tremor on movement: when tremor is light, it may not affect movement function, or it may take care of itself in life;As the disease progresses, tremor can affect some motor functions.For example, it is becoming more and more difficult to write, even unable to write, and unable to take care of themselves in life.
(5) Physical signs associated with tremor: tremor with increased muscle tension is more common in Parkinson's disease. "Gear like" rigidity can be found during examination, and it is easy to find when the head and neck are stretched and flexed, and when the elbow and wrist are passively moved.suchStatic tremorUnaccompaniedAtaxiaThe tendon reflex may not have obvious changes, nor is it accompanied byPathological reflexandSensory disturbance。
treatment
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The treatment of intensified physiological tremor depends on its cause. The intensification of physiological tremor associated with thyrotoxicosis and alcohol withdrawal will be alleviated after treatment of the basic cause. For tremor associated with chronic anxiety, oral benzodiazepines can be used cautiously, 3-4 times a day (for example, diazepam 2-10mg, lorazepam 1-2.5mg, or oxazepam 10-30mg)However, it is necessary to avoid dependence on such drugs. Propranolol 20~80mg orally 4 times a day can often effectively control benign primary tremor and enhanced physiological tremor caused by drugs and acute anxiety state (such as "stage fright" of new actors before their first appearance). Poepidone 50~250mg orally 3 times a day,May be used when propranolol is not effective or can not be tolerated by patients. For some cases of physiological tremor, a small amount of alcohol is very effectiveThere is no effective drug for cerebellar tremor;Physiotherapy and physical therapy measures (such as making the affected limb bear weight, or teaching the patient to pay attention to supporting the proximal end of the limb during limb activities) are sometimes useful
Home care
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Tremor paralysisPatients have many inconveniences in their daily life and need more care and care from their families.The patient's family members need to do the following four kinds of nursing:
1. Clothing: choose zippered clothes that are easy to put on and take off, and clothes with front opening and no need to pull over.The zipper and button can be replaced by nylon chain.Try to wear shoes that do not need to be tied with shoelaces, and do not use shoes with rubber or raw rubber soles, because the patients may fall forward when the shoes touch the ground.
2. Bathing: Lay a layer of anti-skid material such as rubber pad in the bathtub or on the shower board, and place a low stool in the bathtub so that the patient can sit in the shower.Sponges with long grips and gloves for bathing are helpful for patients to bathe.Use an electric razor to shave, and use a paper cup or plastic cup to brush your teeth.
3. Meal: Don't urge the patient to eat and drink quickly because the patient's muscles are uncoordinated.The flexible plastic straw can be used for cold drinks, and the cup with wide handle and light weight can be used for hot drinks.Place a rubber pad under the patient's bowl or plate to prevent slipping.Encourage patients to increase physical activity, drink enough water, add fibrous substances such as vegetables to their daily diet, and use laxatives only when necessary or unavoidable.
4. Prevention of infection: because patients with this disease are prone tobronchitisOr pneumonia, therefore, when cough or fever occurs, it should be handled immediately to avoid serious infection.
