Difference Between Dyskinesia and Tremors

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.

The exact cause of Parkinson’s disease (PD) itself is unknown. It’s thought to result from an interaction among genetic mutations, environmental triggers, and lifestyle risk factors.

There are many conditions besides Parkinson’s disease (PD) that may cause tremor. There are also many different types of tremors other than Parkinson’s tremor. If you have a tremor, don’t assume it’s PD. Be sure to talk with a medical professional and get a diagnosis if possible.

About 80 percent of people with PD experience tremors. Sometimes it’s the very first sign you have the disease. If tremor is your main symptom, you may have a mild and slowly progressing form of the disease.

Tremor typically affects the fingers, hands, jaw, or feet. Your lips and face might also shake. Parkinson’s tremor can occur in any part of your body, but it most often starts first in the fingers. Later, it develop most commonly in the hands, jaw, and feet.

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

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 may be less disabling than other Parkinson’s symptoms, but it’s highly visible. Also, tremor can get worse as your PD progresses.

What is dyskinesia?

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 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’ve been taking it, the more likely you’re to experience this side effect.

Another risk factor for developing dyskinesia is being diagnosed with Parkinson’s at a younger age. The incidence of dyskinesia in Parkinson’s decreases as you age, but it increases the longer you have had PD and taken levodopa.

Not everyone who takes levodopa develops dyskinesia. If you do, it’ll usually be after you have had Parkinson’s for several years.

One study showed that 30 percent of people with Parkinson’s who took levodopa developed dyskinesia after 4 to 6 years of treatment. Only about 10 percent 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 or to consider alternatives, especially if their diagnosis occurred at a younger age. If this is a concern for you, talk with your medical team about other treatment options.

The exact cause of dyskinesia isn’t known. Researchers believe it’s caused by the fluctuation of 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.

How to spot the difference

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

Treating tremor

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 might prescribe you one of these drugs:

  • anticholinergic drugs like amantadine (Symmetrel),benztropine (Cogentin), or trihexyphenidyl (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 PD who have DBS will get partial or complete relief from their tremor.

Treating dyskinesia

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. But this may result in the return of Parkinson’s tremor during the “off” period before your next dose.

Some doctors recommend putting off levodopa treatment or lowering the dosage to avoid the risk of dyskinesia. Other doctors don’t agree with idea of limiting levodopa treatment. They say the effect of dyskinesia is often not severe, although it usually affects a lower limb and can be disabling.

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.

This effectively fools the brain into thinking it’s receiving the necessary dopamine. Dopamine agonists aren’t as strong as levodopa and are thought to be less likely to trigger dyskinesias.

Dopamine agonists can have serious drawbacks. They generally only work for several years unless combined with other medications. Also, they can have serious side effects including heart attack, stroke, and 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 was the first medication that the FDA approved specifically to treat dyskinesia in Parkinson’s.

Amantadine can have serious side effects, including physical symptoms like dizziness and nausea, and mental health conditions like paranoia, hallucinations, and impulsive behavior. A prescription carries a warning about possible suicidal thoughts and worsening mental health conditions.

Takeaway

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

Tremor is a common symptom of PD, which usually appears early in the disease. Dyskinesia is the result of long-term use or high doses of levodopa, the primary medication used to treat PD. Dyskinesia usually doesn’t occur until you have had PD and levodopa treatments for several years.

If you have tremors associated with PD, be sure to talk with your medical team about treatment options. Every case of PD is different. Your individual symptoms and responses to medications will be unique. Also, your medication needs will change as your disease progresses.

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 a caring community.

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