Tremors usually affect the upper limbs, but are also common in the lower limbs, neck, tongue, lips and voice box. For some, tremors might just be an unrelated occurrence not connected to any other disease, while for others they might represent the first signs and symptoms of a serious, underlying, neurological disorder.

Types of tremors

Enhanced physiological tremor: Each one of us is capable of manifesting this type of tremor when subject to certain conditions. It affects both limbs equally, tends to be subtle and is most marked when a sustained posture is attempted [such as keeping hands outstretched for long]. Anxiety, fear, and fatigue, high levels of thyroid hormones and low blood glucose levels could cause this type of tremor. When the underlying cause is treated, the tremors disappear.

Essential tremor: This runs in families and is fairly common. So if either of your parents experiences this type of tremor, there’s a 50 per cent chance that you might too. Usually, the tendency becomes evident in the middle years of life. It affects the hands, neck and voice box. The tremors are coarser in character and are also more marked when sustained posture is attempted. They may be quite prominent on attempting to perform fine, coordinated movements such as threading a needle. Essential tremor responds moderately well to medication and shows a tendency to deteriorate gradually, as the years pass.

Parkinson’s disease-related tremor: Tremor is one of the most important diagnostic features of Parkinson’s disease [PD] along with other cluster of symptoms. The tremor of PD is coarse and produces a characteristic back and forth movement called the ‘pill rolling’ movement. It is more marked at rest and when the person is relaxed and tends to ease on movement. The tremor classically starts in one or another extremity and involves other limbs sequentially. What is strikingly different in patients with tremor of PD is the coexistence of the other signs and features of PD, which include rigidity, slowing of movements, a mask-like face and sometimes, a sense of poor balance and a tendency to falling. The medications for PD also treat associated tremors.

Other tremors: These are seen in those who suffer from disorders of the motor coordination system in the brain [represented by the cerebellum]. These tremors are characteristically slower and the most coarse of the tremor variants. They are maximal while performing fine, skilled movements and tend to increase as the fine movement is brought to completion. Based on the location of the disease process in the brain, the tremors may affect one or more limbs.

Rarely, a movement resembling tremors may actually be a type of epileptic seizure [convulsion]. This condition, which persists for days to weeks, continues unabated during sleep and does not change its character and intensity with change in position [rest, sustained posture or fine skilled movement] of the affected limb. It arises due to focal damage with irritation to a part of the brain that directs movements of the affected limb.

When you first experience tremors, a volley of questions come to mind. But don’t draw conclusions about the diagnosis, consult a neurologist, who will perform a thorough analysis of the symptoms to zero down on the exact cause.

The tests that might be ordered in course of such an evaluation would include, but may not be restricted to, MRI of the brain and spine, electrophysiological sampling of nerves and muscles and blood tests to assess function of vital organs and to detect the presence of metabolic disorders such as diabetes. In select cases, the urine and blood may be screened for toxins.

In summary, tremors are a common problem. A majority of tremors are usually due to factors that are easily remediable, yet one must never ignore the symptom as it might sometimes represent the harbinger of more ominous neurological disorders. Early diagnosis and timely, appropriate treatment go a long way in avoiding untoward instances.

This was first published in the February 2012 issue of Complete Wellbeing.

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This commonly held belief pertains to certain types of food being ‘good’ or ‘bad’ for the brain. The list of things considered ‘good’ runs from fish and walnut to cauliflower and cabbage. The brain is an energy-intensive organ, critically dependent on adequate levels of glucose in blood and B vitamins.

A regular, well-balanced diet is all that one needs to consume as ‘brain food’. Eggs, wheat germ, unpolished rice, fresh milk and organ meat are good sources of B vitamins. As for ‘bad’ brain foods, there aren’t any.

2. Ageing leads to forgetfulness

Forgetfulness is often considered to be a part and parcel of the ageing process—an inescapable reality that comes with growing old; nothing can be farther from the truth than this!

There exists sufficient scientific evidence to prove that normal ageing, while associated with mild decline in the speed of processing and acquiring new skills, is NOT associated with forgetfulness or a state of dependence.

Serious and frequent lapses in memory could be a sign of dementia, a condition for which the causes range from multiple strokes and Alzheimer’s disease to brain tumours and infection. Early detection of dementia can significantly attenuate the progress of Alzheimer’s disease and reverse changes due to infection and nutritional deficiency.

3. The bigger the brain, the smarter one is

This is a misconception that even many educated and well-informed people subscribe to. By that yardstick, an elephant or sperm whale would surpass even humans for the post of the smartest species on earth, thanks to the size of their brains.

The factors that actually impact the intelligence of a species are the ratio of brain weight to total body weight and the extent of convolutions [called gyri] on the brain surface. The higher the ratio of brain weight to total body weight, the smarter is the organism.

In humans, this ratio is the highest, at about 1:80, while the gargantuan sperm whale’s brain to body weight ratio is about 1:200. No surprise therefore that these gentle mammals do not amuse themselves by playing games of chess with each other on the high seas!

Humans also have the largest number of convolutions per unit area of brain surface. In other words, the human brain is highly folded and compacted on itself allowing an exceptionally large surface area, where complex neural processes take place.

Brains of large mammals like the elephant and the whale are relatively smooth and lack this ingenious infolding of brain tissue. Clearly, in matters of the mind, size does not really matter.

4. Listening to classical music makes children smarter

Another myth that often enjoys currency is that listening to classical music helps brain development. Some other fancy interventions used to ‘smarten up’ children, such as, extensive tutoring, reading classical literature aloud, instructions in ballet dancing and mathematics are also doing the rounds.

There is little scientific evidence to support any of these. Smart parents have smart children because of the transfer of superior genetic material from parents to children. Smart parents tend to be wealthier and can therefore spare the skills or hire the expertise to make their genetically superior offspring brighter than youngsters hailing from less-privileged backgrounds.

5. Epilepsy means madness

Epilepsy, a neurological disorder with a tendency to recurrent seizures [fits] is a fairly common condition. Unfortunately, this disorder has earned some uncanny associations, including possession states and mental subnormality.

The fact is that the vast majorities of patients with epilepsy are intellectually competent and can function as effective and contributory members of society. They are often not the preferred choice in the employment market and tend to be stigmatized by society.

Epilepsy should be understood and accepted as a paroxysmal disorder of the brain; just like migraine and a person with epilepsy should be treated just like any other normal individual. Often, the myths surrounding brain disorders seem absurd and quirky, but for someone who is suffering from a brain disease, these myths could prove to be discriminatory and hurtful.

Hence, a deeper understanding of this mysterious organ would pave the way for a better management of its disorders.

This was first published in the May 2011 issue of Complete Wellbeing.

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