Tremor and dyskinesia are two kinds of uncontrollable movements that affect some people with Parkinson’s disease. They both cause your body to move in ways you don’t want it to, but they each have unique causes and produce different types of movements.
Here’s how to tell if the involuntary movements you’re experiencing are tremor or dyskinesia.
What is tremor?
Tremor is an involuntary shaking of your limbs or face. It’s a common symptom of Parkinson’s disease that’s caused by a lack of the chemical dopamine in the brain. Dopamine helps to keep your body movements smooth and coordinated.
About 80 percent of people with Parkinson’s disease experience tremors. Sometimes it’s the very first sign you have the disease. If tremor is your main symptom, you probably have a mild and slowly progressing form of the disease.
Tremor typically affects the fingers, hands, jaw, and feet. Your lips and face might also shake. It can also look different, depending on which body part is affected. For instance:
Finger tremor looks like a “pill rolling” motion. The thumb and another finger rub together in a circular motion that makes you look like you’re rolling a pill between your fingers.
Jaw tremor looks like your chin is shivering, except the movement is slower. The tremor can be intense enough to make your teeth click together. It will usually go away when you chew, and you can eat without a problem.
Foot tremorhappens when you’re lying down or if your foot is hanging (for example, over the edge of your bed). The movement might only be in your foot, or throughout your entire leg. The shaking usually stops when you stand up, and it shouldn’t interfere with walking.
Head tremor affects about 1 percent of people with Parkinson’s disease. Sometimes the tongue shakes too.
A Parkinson’s tremor happens when your body is at rest. This is what separates it from other types of shaking. Moving the affected limb will often stop the tremor.
The tremor might start in one limb or side of your body. Then it can spread within that limb — for example, from your hand to your arm. The other side of your body might eventually shake as well, or the tremor could stay on just the one side.
A tremor is less disabling than other Parkinson’s symptoms, but it’s highly visible. People might stare when they see you shake. Also, tremor can get worse as your Parkinson’s disease progresses.
What is dyskinesia?
Dyskinesia is an uncontrollable movement in a part of your body, such as your arm, leg, or head. It can look like:
Dyskinesia is caused by long-term use of levodopa — the primary drug used to treat Parkinson’s. The higher the dose of levodopa you take, and the longer you’re on it, the more likely you are to experience this side effect. The movements may start when your medicine kicks in and dopamine levels rise in your brain.
How to spot the difference
Here are a few tips to help you figure out whether you have tremor or dyskinesia:
- shaking movement
- happens when you’re at rest
- stops when you move
- typically affects your hands, feet, jaw, and head
- might be on one side of your body, but can spread to both sides
- becomes worse when you’re under stress or feeling intense emotions
- writhing, bobbing, or swaying movement
- affects the same side of your body as other Parkinson’s symptoms
- often starts in the legs
- caused by long-term use of levodopa
- may appear when your other Parkinson’s symptoms improve
- gets worse when you’re under stress or excited
Tremor can be difficult to treat. Sometimes it responds to levodopa or other Parkinson’s drugs. However, it doesn’t always get better with these treatments.
If your tremor is severe or your current Parkinson’s medication isn’t helping to control it, your doctor might prescribe you one of these drugs:
- anticholinergic drugs like amantadine (Symmetrel), benztropine (Cogentin), or trihexiphenidyl (Artane)
- clozapine (Clozaril)
- propranolol (Inderal, others)
If medication doesn’t help with your tremor, deep brain stimulation (DBS) surgery can help. During DBS, a surgeon implants electrodes in your brain. These electrodes send small pulses of electricity to the brain cells that control movement. About 90 percent of people with Parkinson’s disease who have DBS will get partial or complete relief from their tremor.
DBS is also effective for treating dyskinesia in people who’ve had Parkinson’s for several years. Lowering the dose of levodopa you take or switching to an extended-release formula can help control dyskinesia as well. Amantadine extended release (Gocovri) treats this symptom too.