Tremor is the most common of all abnormal movements. When it present one notes in location (the head, eyelids, lips, the jaw, tongue, arms or legs), rate, amplitude, and rhythm. The tremor may be designated as slow, moderate or rapid (4, 5, 6, 8, or 10 oscillations per second), coarse, medium or the fine, and regular or irregular.
The tremor may occur while the patient is at rest (frequently, but not always, in paralysis agitans); it may be intensified by action or intention (e.g. multiple sclerosis); it is usually increased by emotional excitement and generally disappears during sleep. One also speaks of motofacient (when it is found in the muscles participating in the action) and motofacient tremor. That which occurs in fatigue states neurotic persons is generally coarse, while the functional tremor seen in exophthalmia goiter is rapid and fine, especially noticeable in the fingers of the outstretched hands. There is the lip and tongue tremor of the alcoholic in addition to the tremor of the hands, the perioral tremor of the paretic, and the neurotic lid tremor. Other toxic tremors are seen in various states of chronic poisoning (mercury, lead, tobacco, etc).
The senile head tremor (also of the jaws and lips), probably cerebellar in origin, simulates the tremor of multiple sclerosis but it is generally unaccompanied by rigidity. Finally, there is an involuntary rhythmic head rolling occasionally observed in rickety children below the age of two years. Spasmus nutans, seen in babies between the ages of six and twelve months, consist of rhythmic nodding or rotatory tremor of the head and is frequently accompanied by nystagmus. Closing of the eyes stops the tremor while forcible control of the tremor increases the nystagmus. Fibrillations are generally slow, vermicular twitching of individual muscle fibers.
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