What Is a Pill Rolling Tremor?

Medically reviewed by Seunggu Han, MD on November 8, 2017Written by Erica Hersh on November 8, 2017

What is it?

A pill rolling tremor is a tremor named for how it appears. If you have a pill rolling tremor, it looks like you are trying to roll a pill or another small object between your thumb and index finger. It’s a resting tremor, which means that it’s most likely to happen when your body is relaxed rather than when you’re using your hands.

A pill rolling tremor is the most common tremor associated with Parkinson’s disease, a nervous system disorder that affects movement. It’s usually one of the earliest symptoms of Parkinson’s disease.

What causes it?

Tremors are caused by problems in the parts of the brain that control movement, including the cerebellum, frontal lobe, and basal ganglia. Some types of tremors can be inherited. Others are caused by factors such as:

However, most types of tremors have no known cause.

Tremors in general are one of the major symptoms of Parkinson’s disease, occurring in approximately 70–80 percent of cases. In Parkinson’s disease, nerve cells in a part of the brain called the basal ganglia start to die and produce less of a neurotransmitter called dopamine. The basal ganglia use dopamine to form connections and communicate between neurons, so when there’s less dopamine, there aren’t proper connections and communication.

The basal ganglia are responsible for making sure your body movements are smooth. When there aren’t as many connections in this area of the brain, they can’t do their job as well, leading to tremors and the other movement symptoms of Parkinson’s disease.

Pill rolling tremors can be caused by other degenerative neurological conditions, such as multiple system atrophy or Lewy body dementia. However, this type of tremor is almost always caused by Parkinson’s disease.

The conditions that can cause pill rolling tremors are all serious conditions, so if you have developed a pill rolling tremor, it’s important to see your doctor as soon as possible.

Who’s at risk?

Because a pill rolling tremor is usually caused by Parkinson’s disease, the biggest risk factors for this type of tremor are the same as the risk factors for Parkinson’s. While the causes of Parkinson’s disease are unknown, risk factors include:

  • Age. Parkinson’s disease usually develops around age 60 or older.
  • Sex. Men are more likely than women to develop Parkinson’s disease.
  • Family history. Approximately 15–20 percent of people with Parkinson’s disease have relatives with the condition. However, there’s no known genetic cause of Parkinson’s disease.
  • Environmental factors. Some studies show that ongoing exposure to certain pesticides and other chemicals can slightly increase your risk of Parkinson’s disease.

What are the symptoms?

Tremors, especially resting tremors, are a very common symptom of Parkinson’s disease, but there are other early symptoms you might notice, including:

  • muscle stiffness, which can lead to difficulty moving
  • slowed movements (bradykinesia)
  • difficulties balancing
  • stooped posture
  • difficulties walking, which can lead to shuffled steps or feelings of unsteadiness
  • speech changes, including slurring your words, speaking more softly and quickly, and becoming monotone

Treatment options

In most cases, tremors can’t be cured. However, you can help reduce your tremor symptoms by treating the underlying cause of the tremor.

A pill rolling tremor caused by Parkinson’s disease can be eased with medication for Parkinson’s, such as levodopa and carbidopa.

In some cases of advanced Parkinson’s where other medications haven’t worked, deep brain stimulation can be used. In this treatment, electrodes are placed in the basal ganglia. They send small amounts of electricity into the brain, which helps reduce tremors.

Even with treatment, pill rolling tremors caused by Parkinson’s disease usually spread to the rest of the arm and the other side of the body over a span of a few years.

In many cases, stress or anxiety can make tremors worse, regardless of the underlying condition. Finding ways to relax, such as focusing on a hobby or taking up meditation, can help reduce your pill rolling tremor.

Some people also find that when a pill rolling tremor is minor, they can suppress it by squeezing a ball, pen, or other small object.

Outlook and prevention

There isn’t any conclusive, evidence-backed way to prevent Parkinson’s disease or the tremors associated with it. But early diagnosis and treatment of Parkinson’s can help control your symptoms and reduce complications. Because pill rolling tremor is an early symptom of Parkinson’s disease, you should see a doctor if you start having this symptom.

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