01 Sep 2010
When Mr Kuan Poh Chye Goh, a sprightly, healthy 72-year-old, picks up a cup, pen or spoon, his hand shakes uncontrollably. “I can’t do anything about the shaking,” said Mr Kuan.
When the trembling began 10 years ago, Mr Kuan dismissed it as a normal part of ageing. But when the shaking became more frequent and severe, affecting his daily activities, he turned to National Neuroscience Institute (NNI) for help.
Although shaky hands are a common condition that can affect anyone, older people, especially those aged above 50, are more prone to this disorder. It can be due to a variety of reasons, including Parkinson’s disease, alcohol consumption, thyroid-related problems, kidney or liver failure, or certain drugs.
Shaking can also be due to essential tremors, a condition which Mr Kuan was diagnosed with following a series of tests.
Little is known about what causes the condition. But “what we do know about essential tremors is that some cases may be progressive and associated with other neurodegenerative diseases such as Parkinson’s disease”, said Associate Professor Tan Eng King, Senior Consultant and Clinician Scientist, Department of Neurology, NNI.
“The most recognisable feature is a tremor of the arm that occurs during voluntary movement such as eating, writing or holding a cup. It usually begins with the hands and occurs when the affected muscle is in use. So when the hand is at rest, there is no shaking,” he said.
Although trembling of the hands is a common symptom of essential tremors, shaking of the head, arms, voice, tongue, legs and trunk may also occur. The disorder usually affects both sides of the body, though one side can be more severely affected. Heightened emotion, stress, physical exhaustion or low blood sugar may bring on the tremors and increase their severity.
Between 0.5 and five per cent of Singaporeans are estimated to be affected, but this is likely an underestimate as many cases go undiagnosed, said Assoc Prof Tan.
People who suffer from essential tremors are frequently treated with drugs. They are also often asked to adjust their worklife balance and get more rest. In severe cases, deep brain stimulation may be necessary.
In this procedure, a tiny electrical device is inserted into the part of the brain responsible for causing tremors. Much like a pacemaker, the device sends out electrical impulses that reduce the tremors.
“It is important to see a doctor the moment tremors of any sort appear consistently.
Sometimes people don’t realise their condition, so family members should point it out to them, however mild it is, because it can worsen over time,” said Assoc Prof Tan.
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