Hand tremors alcohol
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Hand Tremors and Alcohol: A Comprehensive Overview
Alcohol Withdrawal Tremor: Characteristics and Mechanisms
Nature of Alcohol Withdrawal Tremor
Alcohol withdrawal tremor is primarily a postural tremor, meaning it is most noticeable when the limbs are held in a stationary position. This type of tremor is significantly larger in amplitude compared to normal postural tremor, although it occurs at a similar frequency. The tremor is not synchronized between both hands, suggesting that a central pacemaker is not involved in its genesis4.
Mechanisms Behind Alcohol Withdrawal Tremor
The increased tremor during alcohol withdrawal is attributed to the entrainment of asynchronously firing motoneurons by 1A muscle spindle afferents. Additionally, the tremor is exacerbated by the synchronous firing of motoneurons at a frequency of 9 to 10 Hz due to oscillations in the stretch reflex control system. The beta-adrenergic receptor blocking drug, propranolol, has been shown to reduce tremor by decreasing the synchrony of motor units rather than the total number of units involved in maintaining limb posture4.
Quantitative Analysis of Alcohol Withdrawal Tremors
Correlation Between Hands
A study evaluating the relationship between tremors in the left and right hands of patients with Alcohol Withdrawal Syndrome found a weak correlation between the tremor frequencies of both hands. However, expert physician ratings of tremor severity showed a much stronger correlation, suggesting that clinical assessments may be more reliable than frequency measurements alone5.
Measurement Techniques
Using smartphones to collect tremor data and applying a model to estimate tremor ratings, researchers found a strong correlation between the estimated tremor ratings of each hand. Averaging the tremor ratings of both hands provided the most accurate single tremor rating estimate, with lower estimation errors for higher frequency tremors5.
Alcohol and Essential Tremor
Alcohol's Effect on Essential Tremor
Alcohol has been reported to significantly reduce tremor amplitude in patients with essential tremor. This effect is believed to be due to alcohol's action on sensitive structures within the central nervous system, rather than peripheral tremorogenic mechanisms. This central action distinguishes essential tremor from other types of tremors that arise from peripheral oscillations9.
Clinical Observations
In a study of 678 essential tremor patients, 74% reported that alcohol ingestion decreased their tremor. This effect was observed within 15 minutes of consuming small doses of ethyl alcohol. The study concluded that alcohol acts specifically on central nervous system structures to alleviate tremor8 9.
Motoric Signs in Alcohol-Dependent Patients
Hand Tremor and Body Sway
Alcohol-dependent patients exhibit enhanced hand tremor and body sway during withdrawal. These motoric abnormalities tend to remit with continued abstinence, suggesting a subclinical cerebellar dysfunction. In contrast, cocaine-dependent patients show persistent resting tremor but normal body sway and action tremor, indicating different underlying mechanisms for tremor in these populations3.
Resting Hand Tremor in Abstinent Patients
Patients with a history of alcohol dependence exhibit less resting hand tremor compared to those with histories of cocaine dependence. This finding suggests that chronic cocaine abuse may downregulate dopaminergic function in the basal ganglia, leading to more pronounced tremor1.
Conclusion
Hand tremors associated with alcohol dependence and withdrawal present distinct characteristics and underlying mechanisms. Alcohol withdrawal tremor is primarily a postural tremor, significantly larger in amplitude than normal postural tremor, and can be mitigated by propranolol. Quantitative analyses reveal that clinical assessments of tremor severity are more reliable than frequency measurements. Additionally, alcohol has a notable effect on reducing essential tremor, acting on central nervous system structures. Understanding these nuances is crucial for developing effective treatment strategies for tremor in alcohol-dependent patients.
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Most relevant research papers on this topic
Resting hand tremor in abstinent cocaine-dependent, alcohol-dependent, and polydrug-dependent patients.
Resting hand tremor is more common in patients with histories of cocaine dependence, alcohol dependence, and polydrug dependence, and is positively related to use and negatively related to abstinence duration.
Observational StudyA curvilinear relationship between alcoholic withdrawal tremor and personality.
Alcoholic withdrawal tremor is influenced by personality, with high stress individuals experiencing increased tremor after relaxation therapy, while the least stressed individuals experience decreased tremor.
Non-RCTMotoric signs of CNS dysfunction associated with alcohol and cocaine withdrawal
Alcohol and cocaine withdrawal cause different patterns of motoric dysfunction, with cerebellar dysfunction in recovering alcohol-dependent patients and extrapyramidal dysfunction in cocaine-dependent patients.
Non-RCTThe Nature and Etiology of Normal and Alcohol Withdrawal Tremor
Alcohol withdrawal tremor is a postural-type tremor, with both normal and alcohol withdrawal tremors affecting limb posture, and propranolol reduces both types by decreasing synchrony of motor units.
A quantitative evaluation of alcohol withdrawal tremors
Alcohol withdrawal tremors in patients' hands show a weak correlation in frequency, but a strong correlation in expert physician ratings, with higher frequency tremors having a lower estimation error.
Observational StudyFinger tremor in alcoholic patients.
Alcoholic patients have a higher amplitude of finger tremor compared to normal control subjects, and psychiatric history and organic illness should be considered in interpreting the results of studies on tremor in alcoholic patients.
Observational StudyOctanoic acid in alcohol-responsive essential tremor
A single 4-mg/kg dose of octanoic acid is not effective in reducing postural tremor in patients with alcohol-responsive essential tremor at 80 minutes, but is effective after 180 minutes.
RCT
Very Rigorous JournalThe relationship of essential tremor to other movement disorders: Report on 678 patients
Essential tremor patients have a higher frequency of Parkinson's disease than the general population, and other movement disorders are infrequently observed.
Observational Study
Highly CitedThe effect of alcohol on essential tremor
In patients with essential tremor, ethanol specifically affects sensitive structures within the central nervous system, while having no effect on peripheral tremorogenic mechanisms.
Highly CitedEssential tremor
Essential tremor is a single disease entity with variable expression, despite its bimodal distribution and associated conditions.
Observational StudyHighly Cited