Lip Tremors: Causes and When to Seek Medical Advice

Trembling of the lower lip?

Hello Dr.
Jiang, my mother (65 years old) has been experiencing occasional tremors in her lower lip over the past two months, which she is not aware of.
She has not had this issue before.
In May of this year, she developed urticaria and was on corticosteroids for six weeks.
During this time, we noticed rapid up-and-down movements in the middle of her lower lip, and her back also exhibited tremors.
When asked, she felt the tremors in her back but not in her lower lip.
After discontinuing the corticosteroids, the back tremors ceased.
Last month, she visited a neurologist for an examination; her limbs were strong, and her gait was normal.
Blood tests and a brain CT scan (without contrast) were performed, and all results were normal.
While waiting for the CT scan, she appeared nervous, and I noticed tremors in her head and neck at that moment.
(My mother has osteoporosis and receives denosumab injections every six months.) To this day, the tremors in her lower lip persist.
Could this be a residual side effect of the corticosteroids, or could it be indicative of another issue? Should she undergo further medical evaluation or testing? Thank you!

YF, 30~39 year old female. Ask Date: 2020/08/05

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it may be necessary to consider essential tremor.
If it does not affect your daily life, medication treatment is not required.
The causes of tremors can be categorized into four types: physiological tremors, psychological tremors, essential tremors, and pathological tremors.

1.
Physiological tremors: These do not occur under normal circumstances but can happen in specific situations such as stress, anxiety, or anger.
Some medications, such as bronchodilators, as well as the consumption of beverages like coffee, tea, or cola, can also lead to physiological tremors.
2.
Psychological tremors: These may occur intermittently without a fixed pattern.
Treatment focuses on addressing the underlying mental health issues and managing stress.
3.
Essential tremors: The exact cause of the tremors cannot be identified; they may be due to a unique constitution or hereditary factors.
Typically, tremors are more pronounced when holding objects, while some individuals may experience tremors when writing or performing specific movements.
4.
Pathological tremors: These are caused by dysfunction in the nervous system, such as in Parkinson's disease, lesions in the midbrain, cerebellum, or basal ganglia, or metabolic abnormalities (e.g., hypoglycemia or hyperthyroidism).
These types of tremors tend to be more persistent.
I recommend consulting a neurologist for discussion and treatment.
Wishing you good health and peace.
Dr.
Jiang, Neurology Department, Taoyuan Hospital, cares about you.

Reply Date: 2020/08/05

More Info

Lip tremors, particularly in the context you've described, can be concerning and may arise from various underlying causes. Given your mother's recent medical history, including her use of corticosteroids for urticaria and her current symptoms, it's essential to consider several factors.

Potential Causes of Lip Tremors
1. Medication Side Effects: Corticosteroids can have a range of side effects, but tremors are not the most common. However, they can lead to muscle weakness or changes in muscle tone, which might contribute to tremors in some individuals. It's also possible that the stress of her medical condition and the anxiety associated with it could lead to muscle tension and tremors.

2. Neurological Issues: While her neurological examination was normal, tremors can sometimes be subtle and not easily detected during a routine exam. Conditions such as essential tremor, Parkinson's disease, or other movement disorders could present with lip tremors. The fact that she experienced tremors in her back previously could suggest a neurological component, although it resolved after stopping the steroids.

3. Anxiety and Stress: The observation that her lip tremors were more noticeable during a stressful situation (waiting for a CT scan) suggests that anxiety could be a contributing factor. Stress and anxiety can lead to muscle tension and involuntary movements.

4. Electrolyte Imbalances: Corticosteroids can affect electrolyte levels, particularly potassium and calcium. Given your mother's osteoporosis and treatment with denosumab, it's essential to monitor her calcium levels, as imbalances can lead to muscle spasms or tremors.

5. Other Medical Conditions: Conditions such as thyroid disorders, vitamin deficiencies (like B12), or even dehydration can lead to tremors. It's important to ensure that these have been ruled out through appropriate blood tests.

When to Seek Further Medical Advice
Given that your mother has persistent lip tremors, it would be prudent to seek further medical evaluation, especially since:
- The tremors have not resolved after stopping the corticosteroids.

- They are occurring daily and are noticeable to family members.

- There is a history of anxiety that could be exacerbating the situation.

Recommended Actions
1. Follow-Up with a Neurologist: Since she has already seen a neurologist, it may be beneficial to return for a follow-up appointment. Discuss the persistence of the tremors and any new symptoms that may have developed.

2. Additional Testing: Depending on the neurologist's assessment, they may recommend further tests, such as an electromyography (EMG) to evaluate muscle activity or additional imaging studies to rule out any underlying neurological conditions.

3. Monitor Stress and Anxiety Levels: If anxiety is suspected to be a contributing factor, consider discussing this with her primary care physician or a mental health professional. Stress management techniques, such as mindfulness or relaxation exercises, may help alleviate symptoms.

4. Review Medications: Ensure that all medications, including over-the-counter supplements, are reviewed by her healthcare provider to rule out any interactions or side effects that could be contributing to her symptoms.

5. Regular Monitoring: Keep track of the frequency and severity of the tremors, as well as any other symptoms that may arise. This information can be valuable for her healthcare provider in determining the best course of action.

In conclusion, while the lip tremors may be benign, especially if they are not accompanied by other neurological symptoms, it is essential to continue monitoring her condition and seek further medical advice if the symptoms persist or worsen. Your proactive approach in seeking information and understanding her symptoms is crucial in managing her health effectively.

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