Q My mother's hand has developed a shake. She maintains it happened during a stressful time last summer and that it goes away when she's not stressed. She also says she's been to her GP about it and he told her not to worry.
But I've been observing her closely and even when she doesn't seem stressed, she still has the shake. She's quite independent, still drives, is generally in good health and is in her late 70s. But this is really worrying me. Should I make her get a second opinion?
A It is only natural to worry about your elderly mother. The majority of people with a tremor will jump to the worst case scenario and be fearful of a diagnosis of Parkinson's disease (PD). The diagnosis of PD can be challenging early on. Unfortunately, there is no single diagnostic test (blood test or brain scan) and expert clinical opinion is usually required especially when patients present early with the disease. Remember benign physiologic tremors can occur with hyperthyroidism, low blood sugars or due to a medication side effect. If these simple things are corrected, the tremor resolves.
The typical tremor seen in PD is called a 'rest tremor.' In other words, the shake occurs when the affected body part is fully supported against gravity and completely at rest. The rest tremor can be temporarily dampened or abolished during voluntary action (deciding to move the affected body part). Rest tremors can fluctuate in severity depending on whether the person feels under observation, under stress or during excitement/recent exercise. The rest tremor in PD is typically on one side (unilateral) and occurs first in one hand or less commonly in one leg but may also involve the face, lip or jaw. Rest tremors can follow a relatively benign course, can progress over time to PD, or be part of another neurological disease such as Parkinsonian syndrome.
However, there are three cardinal signs of Parkinson's disease, namely, bradykinesia (a gradual loss and slowing down of spontaneous movement), gait disturbance (deviation from the normal walking pattern) and postural instability (difficulty maintaining balance and loss of righting reflexes). This must be accompanied by a least one more clinical sign, either rest tremor (as described above) or rigidity (abnormal stiffness in a limb or part of the body) in order to consider a diagnosis of PD. Rigidity is often elicited during a clinical examination as the classic 'lead-pipe resistance' of passive movement (when someone else moves your arm for you).
I think you are in a rather delicate situation as your mother has reassured you that her doctor says there is nothing wrong. You can take her reassurance and try to keep a closer eye on her, watching out for the above-mentioned signs/symptoms yourself. Alternatively, you could ask her to attend your GP with you for a more complete reassurance on your part. After obtaining a full history and performing a complete neurological examination, it may be possible for your doctor to determine if this shake is anything to worry about.
Lastly, you should respect her right to privacy, as her doctor may have told her something entirely different. It her right to decline pursuing the matter any further for now as the tremor is clearly not affecting her ability to drive or perform her activities of daily living.
⬤ Dr Jennifer Grant is a GP with the Beacon HealthCheck
Health & Living