The Difference Between Dyskinesia and Tremors

Tremor is a neurological symptom involving involuntary shaking of your limbs or face. It’s a common symptom of Parkinson’s disease and occurs due to a lack of the chemical dopamine in the brain. Dopamine helps to keep your body movements smooth and coordinated.

The exact cause of Parkinson’s disease (PD) itself is unknown. But it may result from an interaction between:

• genetic mutations
• environmental triggers, such as exposure to certain toxins
• other factors, including damage to mitochondria in the brain

About 80% of people with PD experience tremors, and for some, it is the first indicator of PD. Parkinson’s tremor can occur in any part of your body, but it often starts first in the fingers.

Tremor in different parts of the body

Parkinson’s tremor may look different, depending on the part of the body affected. For instance:

• Jaw tremor: With a jaw tremor, your chin may appear to shiver, except the movement is slower. It may be intense enough to make your teeth click together. It usually goes away when you chew, and you can eat without a problem. Chewing gum may help.
• Facial tremor: This refers to a twitching of the face, such as the lips and jaw, when you’re at rest. It’s associated with older age and a longer duration of PD. One study reported that only 1.7% of the participants had facial tremor at the time of PD onset, but after 9 years, 14% of people with PD had facial tremor.
• Tongue tremor: This type of tremor rarely occurs as an early symptom and often develops after tremor in the body extremities, like the hands or feet. It happens when you’re at rest. If severe, it can make your head shake.
• Finger tremor: A finger tremor looks like a “pill rolling” motion. The thumb and another finger rub together in a circular motion, making you look like you’re rolling a pill between your fingers.
• Hand and arm tremor: The hand or arm may move at rest. This typically stops if you move it.
• Foot and leg tremor: Foot tremor can happen when lying down or your foot is dangling. The movement may affect the foot or the entire leg. The shaking usually stops when you stand up and doesn’t often interfere with walking.
• Head tremor: This type affects about 1% of people with PD. Sometimes, the head doesn’t shake on its own, but rather when the tremor of an arm affects the head.

A Parkinson’s tremor happens when your body is at rest. This is what distinguishes it from other types of shaking. Moving the affected limb often stops the tremor.

The tremor might start in one limb or side of your body and can eventually progress within that limb. For example, it can progress from your hand to your arm. The other side of your body may eventually shake, or the tremor could stay on just one side.

Tremor can worsen as PD progresses.

Dyskinesia is an uncontrollable movement in a part of your body, like your arm, leg, or head. It can look like:

• twitching
• writhing
• fidgeting
• twisting
• jerking
• restlessness

Dyskinesia results from the long-term use of levodopa — the primary drug used to treat Parkinson’s. The likelihood of developing this side effect increases the longer you’ve been taking levodopa and the higher your dose. If you develop PD and begin taking levodopa at a young age, you may be more likely to have dyskinesia than someone who develops PD at an older age.

Not everyone who takes levodopa develops dyskinesia. If you do, it’ll usually be after you’ve been treated with medication for Parkinson’s for several years.

One study showed that 30% of people with Parkinson’s who took levodopa developed dyskinesia after 4 to 6 years of treatment. About 10% of those cases were severe.

Because of the risk of developing dyskinesia when taking levodopa, some people with Parkinson’s choose not to take the drug and consider alternatives, especially if diagnosed at a younger age.

If this concerns you, you can talk with your medical team about other treatment options.

The exact cause of dyskinesia isn’t known. Researchers believe it’s caused by fluctuating the level of certain chemicals in your brain, especially dopamine. This happens because of the unavoidable rise and fall of your dopamine levels when you take levodopa.

Here are a few tips to help you figure out whether you have tremor or dyskinesia:

Parkinson’s tremor can be difficult to treat. Sometimes, it responds to levodopa or other Parkinson’s drugs. But 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 may prescribe a different medication, such as:

• anticholinergic drugs like amantadine (Symmetrel),
  benztropine (Cogentin) or trihexyphenidyl (Artane)
• clozapine (Clozaril)
• propranolol (Inderal)

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% of people with PD who have DBS will get partial or complete relief from tremor.

Treating dyskinesia can include:

• DBS, which can reduce dyskinesia because people can take a lower dose of levodopa to control their tremor
• dosage changes, such as lowering your dose of levodopa
• alternate medications, such as dopamine agonists
• medications to treat dyskinesia

Dyskinesia is usually tolerable when it first starts, although it can sometimes affect a lower limb, and it may eventually become disabling for some people.

Lowering the dose of levodopa you take or switching to an extended-release formula may help control dyskinesia. But this may result in the return of Parkinson’s tremor during the “off” period before your next dose.

Sometimes, doctors recommend putting off levodopa treatment or using a low dosage to avoid the risk of dyskinesia, and sometimes, it is not appropriate to limit levodopa treatment.

Dopamine agonists can be useful in treating PD, with less risk of causing dyskinesis. These drugs mimic the actions of dopamine when levels are low and effectively fools the brain into thinking it’s receiving the necessary dopamine. Dopamine agonists may be less likely to trigger dyskinesia.

But they generally only work for several years unless combined with other medications. They may also cause serious complications, such as:

• heart attack
• stroke
• worsening mental health conditions

Amantadine (Gocovri) also helps reduce dyskinesia in Parkinson’s. In 2017, the FDA approved an extended-release form of the drug. It is the first FDA-approved medication to treat dyskinesia in Parkinson’s.

Amantadine can potentially have serious side effects, including:

• dizziness
• nausea
• mental health conditions like paranoia, hallucinations, and impulsive behavior
• worsening mental health conditions
• suicidal thoughts

Is a tremor a type of dyskinesia?

Tremor refers to a shaking movement that occurs due to Parkinson’s, while dyskinesia may look like a writhing, bobbing, or swaying movement that occurs due to long-term use of the medication levodopa to treat Parkinson’s.

What is the difference between dyskinesia and Parkinson’s disease?

Dyskinesia refers to a movement disorder that results from the medication levodopa. It typically develops if you have taken the drug for a long time or at a high dosage. Parkinson’s disease can cause tremor, an involuntary shaking movement. Treatment for Parkinson’s disease may improve this symptom.

What are the symptoms of dyskinesia?

Dyskinesia is an involuntary body movement that may look like twitching, writhing, or jerking.

How can you tell the difference between tremors and Parkinson’s?

While Parkinson’s disease can cause tremor, tremor can also occur with other health conditions, including stress and MS. If you experience tremor, a doctor can perform tests to determine the cause.

Tremor and dyskinesia are two kinds of uncontrollable movements that can affect people with PD. They occur in PD for different reasons and they are different types of movements. If you have PD, it’s important to tell them apart because they may have different treatments.

Parkinson’s tremor can be both physically and emotionally challenging to manage. Your medical team can provide the guidance and support you need. You may also want to join a Parkinson’s support group. You’ll find information, ideas on how to handle challenges, and community.