Generalized Tremor Causes and Treatment

Common Causes of Generalized Tremor

Thyrotoxicosis and hyperthyroidism cause increased sympathetic activity leading to tremor and nervousness, according to the American Heart Association 1
Hyperparathyroidism, particularly in patients with uremia, can present with tremor, as reported by the American Heart Association 1
Multiple systems atrophy (Shy-Drager syndrome) can cause tremor due to altered basal ganglia function, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 4
Conversion disorder may manifest as functional tremor with variable frequency, amplitude, and direction, according to the American Psychiatric Association 5

Functional tremors typically worsen with attention and improve with distraction, as reported by the American Psychiatric Association 5
Flapping tremor (asterixis) suggests hepatic encephalopathy, according to the American Association for the Study of Liver Diseases 2

Beta-blockers, particularly propranolol (80-240 mg/day), are effective for essential tremor and enhanced physiological tremor, as recommended by the American Heart Association 1
Primidone is another first-line option for essential tremor, effective in up to 70% of patients, according to the American Academy of Neurology 3
Gabapentin has moderate efficacy in tremor management, as reported by the American Academy of Neurology 3
Deep brain stimulation (DBS) is preferred for bilateral tremor or younger patients needing adjustable treatment, according to the American Academy of Neurology 3
Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy shows lower complication rates (4.4%) compared to DBS (21.1%) but is not suitable for bilateral treatment, as noted by the American Academy of Neurology 3

For patients with essential tremor, propranolol (80-240 mg/day) or primidone can be used as first-line treatment, as recommended by the American Academy of Neurology 3
For patients with thyrotoxicosis-related tremor, propranolol is the most widely studied beta-blocker for treating increased heart rate and tremor, according to the American Heart Association 1

Beta-blockers should be avoided in patients with chronic obstructive pulmonary disease, bradycardia, or congestive heart failure, as warned by the American Heart Association 3
Common side effects of beta-blockers include fatigue, depression, dizziness, hypotension, and sleep disturbances, as reported by the American Heart Association 3
Regular assessment of tremor severity and medication side effects is essential for optimal management, according to the American Academy of Neurology 3