Autonomic Nervous System Disorders and Muscle Tremors - Neurology

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Autonomic nervous system dysfunction and muscle (exercise) tremors?


Hello, Doctor: I would like to inquire about two aspects related to abnormal neurological and muscular movements:
A.
When I hold a pen with my right hand to write, I experience involuntary tremors that lead to writing difficulties.
Whenever I grip the pen, the tremors occur (if I hold it lightly, there are no issues, but as soon as I apply more pressure, they appear).
This phenomenon began when I was about 14 years old and has persisted for 16 years.
During my school years, I was greatly troubled and distressed by this issue.
After entering the workforce, I write less frequently, so it hasn't significantly impacted my current life and work.
Aside from writing, I do not notice any muscular movement problems with my right hand during other activities (at least I am not aware of any).
When I use my left hand to grip the pen with the same force as my right hand (though I do not write with my left), I do not experience this problem.
Could this be a symptom of "hypotonia," "essential tremor," or another condition? Is there a way to alleviate or cure it?
B.
The muscles at the base of my tongue, both cheeks, and the bridge of my nose involuntarily tremble or twitch when I speak, smile, or apply pressure up and down.
I have only recently become aware of these symptoms over the past 3 to 4 years, and they have become particularly noticeable in the last six months.
I underwent a facial nerve examination at the hospital, which yielded normal results.
Additionally, I experience other symptoms such as tinnitus, dizziness, sudden faintness while walking, easy fatigue, excessive thirst, abdominal bloating, and seeing stars.
Later, during a visit to a psychosomatic clinic, I was clinically diagnosed with "autonomic nervous system dysfunction" and am currently undergoing active treatment.
However, after about a month of treatment, while there has been significant improvement in the aforementioned symptoms, the abnormal muscle movements at the base of my tongue, both cheeks, and the bridge of my nose have not shown noticeable improvement.
Is it possible that these symptoms could also be related to "other neurological conditions" combined with "autonomic nervous system dysfunction"?

Andy, 30~39 year old female. Ask Date: 2024/02/02

Dr. Peng Shiwei reply Neurology


Hello, it is recommended that you visit a neurology or pain management clinic for evaluation.
Thank you.

Reply Date: 2024/02/02

More Info


Understanding the complexities of muscle tremors and autonomic nervous system disorders can be quite challenging, especially when symptoms manifest in various ways. Based on your description, it seems you are experiencing two distinct but potentially interconnected issues: involuntary muscle tremors in your right hand while writing and involuntary movements in the muscles of your face and tongue.


A. Involuntary Tremors in the Right Hand
The tremors you experience when gripping a pen could be indicative of several conditions. Given that this has been a long-standing issue since you were 14, it may be classified as essential tremor or task-specific tremor. Essential tremor is a common movement disorder characterized by rhythmic shaking, often exacerbated by voluntary movements such as writing. It is important to note that essential tremor is not associated with other neurological deficits, which seems to align with your experience since you mentioned that other movements do not provoke tremors.

Another possibility is dystonia, which is a movement disorder that causes involuntary muscle contractions, leading to abnormal postures or movements. In your case, if the tremor occurs specifically when you apply force to grip the pen, it could suggest a form of focal dystonia, particularly if it is task-specific.

To address this issue, treatment options may include:
1. Medications: Beta-blockers (like propranolol) or anticonvulsants (like primidone) are often prescribed to help manage tremors.

2. Botulinum toxin injections: These can be effective for focal dystonias and may help reduce involuntary movements.

3. Physical therapy: Targeted exercises may help improve muscle control and reduce tremors.

4. Surgery: In severe cases, deep brain stimulation may be considered.


B. Involuntary Movements in Facial Muscles
The involuntary movements in your facial muscles, particularly around the tongue, cheeks, and nose, could be related to several factors. Since you have been diagnosed with autonomic nervous system dysfunction, it is possible that these symptoms are manifestations of this condition. The autonomic nervous system regulates involuntary bodily functions, and its dysfunction can lead to a variety of symptoms, including tremors, dizziness, and fatigue.

The fact that you have experienced these symptoms alongside other autonomic issues (like tinnitus, dizziness, and fatigue) suggests that there may be a connection. While your facial muscle tremors have not improved significantly with treatment, it is essential to consider that autonomic dysfunction can sometimes lead to secondary movement disorders.


Potential Overlap and Further Evaluation
Given the complexity of your symptoms, it is crucial to continue working closely with your healthcare providers. Here are some considerations:
1. Neurological Evaluation: A comprehensive neurological assessment, including imaging studies or further electrophysiological tests, may help rule out other neurological conditions such as Parkinson's disease or other movement disorders.

2. Multidisciplinary Approach: Collaborating with neurologists, movement disorder specialists, and autonomic specialists can provide a more holistic view of your symptoms and treatment options.

3. Psychological Factors: Since you have been diagnosed with autonomic dysfunction, stress and anxiety can exacerbate symptoms. Cognitive-behavioral therapy (CBT) or other forms of psychological support may be beneficial.


Conclusion
In summary, the symptoms you are experiencing could be attributed to essential tremor, dystonia, or a combination of autonomic dysfunction and other neurological factors. It is essential to maintain open communication with your healthcare team and explore various treatment options to manage your symptoms effectively. Regular follow-ups and possibly seeking a second opinion from a specialist in movement disorders may also provide additional insights and treatment avenues.

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