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Q: boy of 20 with tremors ( Answered,   1 Comment )
Subject: boy of 20 with tremors
Category: Miscellaneous
Asked by: mimimk-ga
List Price: $8.00
Posted: 30 Dec 2002 11:43 PST
Expires: 29 Jan 2003 11:43 PST
Question ID: 135058
My son is 20.  for some time now I have noticed a slight tremor to his
hands.  He is now complaining of aching in the joint of his right hand
( he is right handed) He has seen a doctor about 9 months ago after my
presitance, but the doctor didn't come up with anything.  Is it normal
for a boy of his age to have this condition?

Request for Question Clarification by journalist-ga on 30 Dec 2002 11:51 PST
This could be caused by many things.  Is it possible for you to share
with a Researcher what conditions were ruled out?  As in what tests
were done?  Also, is he currently taking a doctor's prescription that
contains any amphetamine traces?  Amphetamines sometimes cause hand
tremors.  Any additional information you are able to provide will be
of assistance to the Researcher answering this question.

Request for Question Clarification by vinods-ga on 30 Dec 2002 12:43 PST

I dont think you should be looking here. Just make sure he gets to
some medical facility soon. He needs treatment, he does not need
diagnosis through some non-medical facility like this one, which at
best gives you options to 'similar' situations. Don't be afraid, go
and see a doctor at a good hospial in your area with him. If he does
not comply, find ways to talk/trick him into it or speak to the docs
and see if you can supply them with enough data/information about


Request for Question Clarification by kevinmd-ga on 31 Dec 2002 07:36 PST
Thanks for asking your question.  I cannot address your case
specifically - please refer to your primary care provider for
individual treatment.  However, I am able to answer factual medical
questions.  If you would be willing to rephrase your question to:
"What are diseases that can cause a hand tremor in a 20 year old
male?" - I would be happy to research it.

Subject: Re: boy of 20 with tremors
Answered By: kevinmd-ga on 31 Dec 2002 08:24 PST
Thanks for asking your question.  Although I am an internal medicine
physician, please see your primary care physician for specific
questions regarding any individual cases – please do not use Google
Answers as a substitute for medical advice.  I will be happy to answer
factual medical questions.
You asked the following question:
"What are diseases that can cause a hand tremor in a 20 year old

Basic types of tremor include physiologic, essential, and resting
tremor.  All of these tremor types may affect a young adult male. 
Further discussion of this is addressed below.  I will be happy to
discuss the evaluation and approach to these tremors in a seperate

Tremor is defined as a rhythmic and oscillatory movement of a body
part with a relatively constant frequency and variable amplitude. It
is caused by either alternating or synchronous contractions of
antagonistic muscles. Tremor is the most common of all movement
disorders, occurring from time to time in most normal individuals in
the form of exaggerated physiological tremor (1).

Physiologic tremor

Normal individuals have a very low amplitude, high frequency
physiologic tremor of approximately 10 to 12 Hz that is not visible
under ordinary circumstances. Many factors may enhance the tremor to
the point of detection, most often by increasing sympathomimetic
activity (1).

Common drugs that increase adrenergic activity include beta-adrenergic
agonists such as terbutaline, isoproterenol, epinephrine,
amphetamines, tricyclic antidepressants, levodopa, nicotine, and
xanthines such as theophylline and caffeine.

Anxiety, excitement, fright, muscle fatigue, hypoglycemia, alcohol and
narcotic withdrawal, thyrotoxicosis, fever, and pheochromocytoma also
enhance adrenergic activity.

Miscellaneous drugs and toxins that increase physiological tremor by
other uncertain means include lithium, corticosteroids, sodium
valproate, bromides, mercury, lead, and arsenic.

Enhancement of physiological tremor is the most common cause of
postural and action tremors.

Essential tremor

From UptoDate:
"Essential tremor is the most common neurologic cause of postural or
action tremor, affecting approximately one million individuals in the
United States (2). The incidence increases with age, although it often
affects young individuals, especially when it is familial. By
definition, tremor should be the only neurologic manifestation of
essential tremor." (3)

Some patients with essential tremor also develop enhanced
physiological tremor due to anxiety or other adrenergic mechanisms,
thereby aggravating the underlying tremor. Essential tremor is
typically relieved by small amounts of alcohol; physiologic tremor is
aggravated by caffeine.

Of note, essential tremor has a bimodal distribution (i.e. peak age of
incidence) during the 2nd and 6th decade of life.

Resting tremor

Parkinson's disease is the most common cause of resting tremor. The
tremor is evident with the affected body part supported and completely
at rest and temporarily dampens or disappears during voluntary
activity. Resting tremors usually fluctuate in amplitude and may
appear and disappear depending upon the degree of patient repose,
whether the patient feels he is under observation, or other unknown

The resting tremor in idiopathic Parkinson's disease usually appears
first in one upper extremity. It later spreads to involve the
ipsilateral lower limb followed by the contralateral side; leg or foot
tremor is more commonly due to Parkinson's disease than to essential
tremor. The face, lips, and jaw may be involved but, unlike essential
tremor or cerebellar disease, Parkinson's disease usually does not
produce head tremor.

From UptoDate:
"Parkinson's Disease typically presents in middle and late life.
However, early-onset disease can occur before age 40 years, and a
juvenile form presents before age 20. Most affected children have a
rigid, akinetic disorder, although many have a typical resting
tremor." (4)

Wilson's disease can also present as a resting tremor:
"Clinical manifestations of Wilson's Disease are rare before age 6 and
almost always present before the age of 30 . . . The most common
neurologic findings at first evaluation were dysarthria (97 percent),
dystonia (65 percent), dysdiadochokinesia (58 percent), rigidity (52
percent), gait and postural abnormalities (42 percent), tremor (32
percent), abnormal eye movements (32 percent), hyperreflexia (29
percent), drooling (23 percent), and bradykinesia (19 percent)." (5)

I will be happy to discuss the diagnostic approach to tremor in a
seperate question.  However, I stress that this answer is not
inteneded as and does not substitute for medical advice - please see
your primary care physician for further evaluation of your individual

Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.   
Kevin, M.D.     
Internet search strategy:     
No internet search engine was used in this research. All sources were
from objective physician-written and peer reviewed sources.   

1) Jankovic, J, Fahn, S. Physiologic and pathologic tremors.
Diagnosis, mechanism, and management. Ann Intern Med 1980; 93:460.  
Findley, LJ.
2) Epidemiology and genetics of essential tremor. Neurology 2000;
3) Tarsy, D. Tremor.  UptoDate, 2002.
4) Lucking, CB, Durr, A, Bonifati, V, et al. Association between
early-onset Parkinson's disease and mutations in the parkin gene.
French Parkinson's Disease Genetics Study Group. N Engl J Med 2000;
5) Jankovic, J. Bradykinetic movement disorders.  UptoDate, 2002.
Subject: Re: boy of 20 with tremors
From: spot_tippybuttons-ga on 30 Dec 2002 23:08 PST
There are many, many possible causes of tremors; some more or less
dangerous than others. You should definitely seek treatment and a
second opinion from a different medical professional. As a case in
point, according to his book "Lucky Man", Michael J. Fox's first
symptom of Parkinson's disease was a hand tremor. Because it is
unusual for someone so young to have Parkinson's, it took many months
and several examinations by different doctors before he was correctly

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