Intention Tremor

What is intention tremor?

Intention tremor is rhythmic, involuntary (out of your control) muscle contractions that develop as you try to do a purposeful movement. The contractions can range from mild to severe.

Intention tremor typically affects muscles in your arms or legs. But it can also affect your speech muscles, making your voice sound shaky. It’s a high-amplitude tremor, which means the affected limb moves or “zigzags” significantly.

For example, if you have intention tremor affecting your arm, it’ll shake or tremble as you try to touch your finger to your nose. The closer you get to the intended target (your nose), the worse the tremor becomes.

Healthcare providers often call these tremors cerebellar tremors because they develop from damage to your cerebellum. This is a part of your brain responsible for voluntary movement.

Due to this damage, people with intention tremors often have other neurological symptoms, which may include:

• Rapid, uncontrolled eye movements (nystagmus).
• Inability to do accurate, smooth movements (dysmetria).
• Inability to do rapid alternating muscle movements (dysdiadochokinesia).
• Decreased muscle tone (hypotonia).
• Issues sensing your body’s location, movements and actions (proprioception deficits).
• A wide-based walking pattern and difficulty standing with your feet together (gait ataxia).

There are several different types of tremors. Intention tremors are a subtype of kinetic tremors — tremors that happen with voluntary movement (motions).

Examples of intention (cerebellar) tremors

Examples of actions that intention tremors may affect include:

• Drinking from a cup.
• Moving food to your mouth while eating.
• Picking up or reaching for objects.
• Kicking a ball.
• Pointing to something.

What causes intention tremor?

Damage to your cerebellum can cause intention tremor. Your cerebellum is largely responsible for coordinating voluntary (in your control) movements. Cerebellar damage can affect the communication pathways between your brain and muscles, causing uncontrolled movements (tremor).

Certain conditions and situations can damage your cerebellum, leading to intention tremors. They include:

• Multiple sclerosis (MS). This is the most common cause of intention tremor.
• Stroke.
• Traumatic brain injury (TBI).
• Tumors.
• Alcohol use disorder.
• Wilson disease.
• Spinocerebellar ataxia, ataxia-telangiectasia and Friedreich’s ataxia.
• Hepatocerebral degeneration (a brain condition that can affect people with liver damage).
• Mercury poisoning.
• Certain medications, like antiseizure medications.

What is the treatment for intention tremors?

Treatment for intention tremors involves addressing the underlying cause. For example, if a medication is causing intention tremor, your healthcare provider may recommend stopping the medication or taking a different one.

Some causes of intention tremor, like MS, aren’t curable. But various therapies can help manage the severity of intention tremor.

Examples of treatment include:

• Physical therapy: A therapist can help you improve how your body performs physical movements. Physical therapy may involve exercises like muscle strengthening and gait (walking pattern) rehabilitation.
• Occupational therapy: A therapist can teach you how to do daily tasks more easily while living with intention tremor. This may involve strategies like wearing wrist or ankle weights and relaxation and positioning techniques.
• Medications: Providers typically only recommend medication for people who have intention tremor due to MS.
• Surgery: Thalamic deep brain stimulation may help alleviate intention tremor in people with MS.

When should I see my healthcare provider about intention tremor?

If you develop shakiness in your arm, leg or voice, you should see your healthcare provider. Intention tremor can be a sign of serious underlying conditions. So, getting a proper diagnosis is important.

If you already have an intention tremor diagnosis, see your healthcare provider if:

• The tremor is getting worse over time.
• The tremor is affecting your daily activities.
• The tremor is causing you emotional distress.
• You develop other neurological symptoms, like changes in thinking, behavior or muscle strength.

What’s the difference between essential tremor and intention tremor?

Essential tremor is the most common tremor syndrome. Its key feature is a tremor in both hands and arms during voluntary movement (action tremor) without other neurological symptoms. It can also affect your head, voice or lower limbs.

Intention tremor is a specific type of tremor that develops as you try to do a purposeful movement. It’s a type of action tremor.

Essential tremor can involve different types of kinetic tremors, like postural tremor (shaking that happens when you hold part of your body in a specific pose) and intention tremor.

Does Parkinson’s disease involve intention tremors?

It’s possible to have intention tremors with Parkinson’s disease, but it’s very rare. Parkinson’s disease usually causes resting tremors. These tremors happen in a body part that’s relaxed and completely supported against gravity.

Intention tremors are action tremors.