Why do my legs and arms shake?

The condition in which the legs and arms shake is called in medicine in Latin - tremor, which literally means "trembling".

A completely healthy person may encounter such a phenomenon as unconscious movements of the limbs (rhythmic, very frequent, with different amplitudes), for example, during strong excitement and fear, during an unexpectedly arising stressful situation or significant physical overload. Neurologists do not consider this an anomaly, since the nature of such short-term tremors is physiological, and usually it passes with the disappearance of the provoking factor.

Therefore, we will consider only those cases when legs and arms shake due to one or another disease or pathology.

Causes of trembling legs and arms

Let's start with the simplest case, when the causes of trembling of the legs and arms (and often the entire body) are associated with chronic alcoholism, that is, long-term poisoning of the body with ethyl alcohol. Why do hands and legs shake with alcohol addiction? Because the active metabolite of ethanol, acetaldehyde, causes oxidative stress of brain cells and their atrophy. Neurons and glial cells of the thalamus, hypothalamus and midbrain suffer especially, as well as Purkinje cells in the cerebellum, which regulates muscle tone, human movement and their coordination.

A sufficient number of medications (primarily lithium preparations, neuroleptics, corticosteroids) have involuntary tremors of the limbs associated with temporary encephalopathy in the list of possible side effects.

According to the classification of the main neurological movement disorders, most often the legs and arms shake due to the so-called essential (that is, not having any external cause) tremor or Minor's syndrome - a congenital pathology that descendants receive from ancestors with genes. Moreover, the head, lips, and torso can shake, but most of all - the hands.

Typically, the symptoms of this syndrome begin to appear after age 40, although they can appear at any age. There are no other neurological symptoms, intelligence and life expectancy do not decrease. According to the American National Institute of Neurological Disorders and Stroke (NINDS), if parents have essential tremor, then the chance of developing the disorder in children is 50%.

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Causes of trembling legs and arms: encephalopathy

Encephalopathy is one of the key causes of hand and leg tremors after a stroke, traumatic brain injury, in the presence of a brain tumor or such a systemic disease as multiple sclerosis. The most common and dangerous pathologies of the brain are associated with impaired cerebral circulation in atherosclerosis and arterial hypertension. Insufficient blood supply to the brain often leads to the development of progressive chronic cerebrovascular insufficiency (dyscirculatory encephalopathy or chronic cerebral ischemia) after 45-55 years.

This pathology has an extremely negative effect on the vascular system of the brain and the cellular metabolism of its tissues, affecting almost all of its structures and disrupting many functions. It is impossible to avoid the negative effects on the cerebellum (the role of which was discussed above), therefore, when the extrapyramidal system of the central nervous system is affected, patients complain that their legs and arms are shaking, their head is spinning, and they have problems maintaining balance when walking.

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Causes of trembling legs and arms: hormones and neurotransmitters

Both hormones and neurotransmitters are biologically active substances in the human body, but they have different principles of action. Without going into biochemical complexities, we can define this difference as follows: hormones enter the blood and regulate metabolism and physiological processes, while neurotransmitters ensure the transmission of nerve impulses between neurons by contacting the membranes of nerve cells.

This preamble is not accidental, since the causes of trembling legs and arms include such endocrine diseases as hyperthyroidism and diabetes. With increased activity of the thyroid gland, movement disorders are associated with metabolic disorders: an excess of the hormones triiodothyronine and thyroxine reduces the synthesis of adrenaline, noradrenaline and dopamine by the adrenal medulla - the main neurotransmitters. And the fewer of them, the more difficult it is to transmit nerve impulses in the central nervous system.

Why do hands and feet shake with diabetes? Because insufficient production of insulin by the pancreas leads to such a serious failure in the functioning of the endocrine glands and disturbances in the general metabolism that various forms of diabetic neuropathy develop as a result, including those involving motor nerve fibers.

Finally, movement disorders in which the left arm and leg or both right limbs (i.e. on one side of the body) shake may indicate shaking palsy or Parkinson's disease - a progressive neurological disease that results from the death of neurons in the brain that produce dopamine. A deficiency of this essential neurotransmitter in the basal ganglia of the brain disrupts the functioning of the nigrostriatal pathway, which ensures human motor activity.

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Symptoms of trembling legs and arms

With different pathologies, the symptoms of trembling legs and arms have both differences and similarities. Thus, with increased activity of the thyroid gland, the fingers shake (the trembling is especially noticeable if the arms are raised and stretched forward), and this is diagnosed in neurology as postural tremor (that is, trembling in a certain pose). In addition, general weakness, tachycardia and shortness of breath are noted. Signs of a decrease in blood sugar levels in diabetes - shaking hands and legs and weakness, as well as hyperhidrosis (increased sweating). For this case, the "litmus test" is the sweets eaten: if the limbs stop shaking, then the whole thing is diabetes.

In alcoholism and Minor's syndrome, the symptoms of tremors in the legs and arms correspond to the signs of cerebellar tremor, which occurs in the final phase of any purposeful movement (kinetic tremor) and intensifies with the slightest attempts to tense the muscles of the limbs. But at rest, the tremors pass. By the way, a similar symptom is noted in mercury vapor poisoning.

In patients with Parkinson's disease, the symptoms of tremors in the legs and arms are very specific and are distinguished by the fact that they are most pronounced in a state of rest, when a person is sitting or lying down. But as soon as he starts to perform some actions, the tremors become less noticeable and may stop altogether for a while. The tremors of the hands, characteristic of this disease, are similar to the movement of the fingers when counting coins. Parkinsonism is also characterized by a general reduction in active movements (hypokinesia), including facial movements; general stiffness and prolonged stay in one position (numbness). Damage to the extrapyramidal system is also expressed in a special Parkinsonian gait: the feet are placed parallel to each other, movement is performed in small shuffling steps - first very slowly, and then with noticeable acceleration and a forward tilt of the body.

Diagnosis of trembling legs and arms

When diagnosing tremors in the legs and arms, a neurologist relies on the patient's medical history (including family history) and an examination with an assessment of: general and local motor activity, muscle weakness or atrophy, kinetic deviations in reflex movements, the presence or absence of sensory loss or decreased reflexes.

In Parkinson's disease, this is quite sufficient. In other cases, appropriate hardware and laboratory tests are prescribed, and a specific pathology is determined based on the data: electrocardiogram (ECG), electroencephalogram (EEG), CT or MRI of the brain, electromyogram, cerebral ultrasound angiography, biochemical blood test, thyroid hormone level test in the blood (TSH), thyroid ultrasound.

Treatment of trembling legs and hands

In some cases, treatment of tremors of the legs and arms is aimed at eliminating the causes of this symptom - when possible. And such an opportunity exists at the initial stages of chronic cerebrovascular insufficiency: regulation of blood pressure in patients with hypertension with hypotensive drugs, the use of antiarrhythmic drugs, etc. Therapy for this symptom in chronic cerebrovascular insufficiency consists of maintaining a sufficient level of cerebral circulation.

Ginkgo Biloba (Bilobil, Memoplant) is an antioxidant preparation of plant origin (capsules with Ginkgo Biloba leaf extract) - it has a complex positive effect on many body systems, primarily on vascular tone, general and cerebral blood flow, as well as on the synthesis of norepinephrine, serotonin and dopamine. In case of discirculatory encephalopathy, the product is recommended to be taken during meals (with plenty of water) - one capsule 1-2 times a day; duration of use - up to three months.

In order to improve cerebral blood flow, drugs such as Piracetam (other trade names: Piramem, Cerebropan, Cyclocetam, Eumental, Gabatset, Pyrroxil, etc.) in capsules (0.4 g) or tablets (0.2 g) continue to be used. This drug promotes activation of cerebral blood flow and oxidation-reduction processes in the brain, increases dopamine synthesis. This explains its use in both chronic cerebrovascular insufficiency and parkinsonism of vascular etiology. The dosage recommended by doctors is 0.4 g three times a day (before meals); the maximum daily dose varies depending on the intensity of tremors in the limbs, but should not exceed 4.8 g; the duration of treatment is from 1-1.5 months to six months, with a repeat course after 8 weeks.

Drug therapy for hyperthyroidism involves the endocrinologist prescribing appropriate medications that suppress the production of hormones by the thyroid gland. Treatment can also be surgical and involves thyroidectomy - removal of the thyroid gland (partial or complete).

If the symptoms of essential tremor (congenital Minor syndrome) are mild, no treatment is required. However, in domestic neurology, it is common practice to prescribe a 5% solution of pyridoxine (vitamin B6) by intramuscular injection of 4-8 ml per day for 30 days, with a repeat course of injections twice a year.

Symptomatic treatment of tremors in the legs and arms is carried out with drugs from the beta-blocker group, used in the treatment of hypertension, cardiac arrhythmia and myocardial infarction. By blocking the binding of adrenaline to other hormones, these drugs reduce their effect on beta-adrenergic receptors, reducing the body's response to stress. Most neurologists prescribe Propranolol or Nadolol to patients, as well as anticonvulsants, such as Hexamidine.

Propranolol tablets (synonyms - Anaprilin, Inderal, Betadren, Dociton, Elanol, Naprilin, etc.) are recommended to be taken 20 mg twice (regardless of food). The duration of the course of therapy is determined by the doctor. Nadolon (Anabet, Betadol, Solgol) is taken orally once a day at 40 mg. Both drugs have contraindications: bronchial asthma, tendency to bronchospasm, sinus bradycardia, pulmonary hypertension. During pregnancy and lactation, these drugs are strictly contraindicated.

The anticonvulsant Hexamidine (Primidone, Mizoline, Deoxyphenobarbitone, Prilepsin, etc.) is taken orally, the standard dose is 0.125 g in 1-2 doses; the maximum single dose is 0.75 g, daily - 2 g. This drug is contraindicated in pathologies of the kidneys, liver and hematopoietic system; it causes side effects in the form of dizziness, headache, drowsiness, skin rashes, decreased levels of red blood cells and white blood cells in the blood.

Treatment of tremors in legs and hands in Parkinson's disease

When legs and arms shake due to incurable Parkinson's disease, only symptomatic drug therapy is carried out using a number of special drugs. One of them is Levodopa (Carbidopa, Levokom) - it reduces tremors when prescribed a standard dose - half a tablet (125 mg) 1-2 times a day or a tablet (250 mg) per day or every other day (during meals). The use of this drug may be accompanied by a dystonic state, dizziness, nausea, vomiting, appetite and stool disorders, problems with urination, dry mouth, abdominal pain, urticaria, drowsiness or insomnia, weakness, visual impairment, confusion, etc.

Pramipexole (Pramiprex, Miraxol, Mirapex), a drug available in 0.375 mg tablets, reduces movement disorders in patients with Parkinson's disease. It slows down the destruction of dopaminergic neurons in the brain and has a stimulating effect on the receptors of this neurotransmitter. The recommended standard dose is one tablet (once a day); the dose can be increased by the attending physician every week (taking into account the manifestation of side effects) to a maximum daily dose of 12 tablets (4.5 mg). However, the list of side effects of this drug is extremely extensive, including sleep disorders, hallucinations, memory lapses, depression with suicidal thoughts, decreased blood pressure, heart rhythm disturbances, shortness of breath, inflammation of the nasopharynx, gastrointestinal disorders, pain in various locations, and many others.

Cyclodol (Trihexyphenidyl, Parkopan, Parkinsan, Romparkin, Tremin, etc.) reduces symptoms of tremors in the legs and arms due to its anticholinergic effect. Neurologists prescribe this drug for Parkinson's disease and other pathologies of the extrapyramidal system. Tablets (0.001 g, 0.002 and 0.005 g) are taken after meals - 0.0005-0.001 g per day; the scheme of gradual increase in the dose is prescribed by the doctor to the maximum daily dose - 0.02 g. Cyclodol is not used for glaucoma, irregular atrial contractions, persistent increase in blood pressure and atherosclerosis. Possible side effects of the drug are expressed as dry mouth, ophthalmological disorders, increased heart contractions.

Prevention of trembling legs and hands

It is unlikely that prevention of leg and arm tremors is possible with essential tremor syndrome, Parkinson's disease or multiple sclerosis, but with alcohol tremors you need to stop drinking and undergo a course of body detoxification. Endocrine diseases associated with the thyroid and pancreas, as well as hypertension and atherosclerosis should be treated; do not take self-prescribed medications (to avoid side effects).

As a common preventive measure for this pathology, doctors advise leading a healthy lifestyle. You know very well what this means: eat rationally, avoid stress, exercise (swimming is best), and do not abuse alcohol and coffee. But Western neurologists believe that caffeine can prevent Parkinson's disease.

Considering that in most cases the therapeutic effect on pathologies in which legs and arms shake is symptomatic, the cause of the disease, as well as the disease itself, most often remain. So the prognosis for trembling legs and arms can be formulated as follows: they do not die from this, they live with it, systematically taking medications prescribed by the doctor to reduce the intensity of the symptom.