Pill-Rolling Tremor

A pill-rolling tremor is a common symptom of Parkinson’s disease (PD). Tremor is an involuntary rhythmic movement that a part of your body makes. “Involuntary” means you can’t control the movement. As the name suggests, a pill-rolling tremor looks as if you’re rolling a pill or stone between your thumb and index (pointer) finger.

A pill-rolling tremor is typically a type of resting tremor. In this case, the tremor happens when you’re relaxing your hand and it’s resting on something like a table or your leg. It may get better or go away when you voluntarily move your hand and fingers. Tremors in PD are often asymmetric, meaning they affect one limb or one side of your body. You may just have a pill-rolling tremor in one hand. But it’s possible to develop it in both.

More than 70% of people with PD experience tremor. It’s often the first symptom you get. The condition can cause several forms of tremor that affect your jaw, arms and/or legs. But the pill-rolling tremor is the most common.

Losing control of a part of your body can be distressing. There’s no cure for a pill-rolling tremor. But treatments can make it happen less often or be less noticeable.

What causes a pill-rolling tremor?

The main cause of a pill-rolling tremor is Parkinson’s disease. Tremors in general have several possible causes. They range from brain and neurological conditions to certain medications. It’s possible to have a pill-rolling tremor without Parkinson’s disease. But the tremor commonly happens alongside this condition.

Researchers believe that low levels of dopamine (a chemical messenger) may be to blame for a pill-rolling tremor. This neurotransmitter plays a role in the area of your brain that controls movement, called the basal ganglia.

What is the treatment for a pill-rolling tremor?

Levodopa is the go-to treatment for a pill-rolling tremor in Parkinson’s disease. This medication increases the amount of dopamine in your brain. The increase in dopamine eases Parkinson’s disease symptoms like tremor. Research shows levodopa may reduce up to 80% of tremor. But it’s not always effective. In that case, your provider may recommend other medications like anticholinergics. But these medications may have bothersome side effects, like psychiatric and cognitive (mental) symptoms.

If medications don’t help manage tremors, your provider may recommend certain procedures like deep brain stimulation (DBS). Researchers continue to study treatments for PD symptoms. Your provider will go over all the options with you.

It’s also important to see a mental health specialist if a pill-rolling tremor is causing depression, anxiety or social isolation.

How can I manage a pill-rolling tremor at home?

Aside from getting medical treatment, there are things you can do that may make it easier to live with a pill-rolling tremor. Some examples are:

• Keep your affected hand “busy.” Try squeezing a stress ball or stretching your fingers.
• Eliminate or cut back on drinking caffeine or beverages that contain alcohol. They may make the tremor worse.
• Take your medications on time.
• Reduce stress in your life. Stress and anxiety can make tremors worse.
• Get enough quality sleep. A lack of sleep can worsen some forms of tremors.
• Join a support group to learn from and relate to others who have tremors.

When should I see my healthcare provider about a pill-rolling tremor?

If you develop a pill-rolling tremor without an existing Parkinson’s disease diagnosis, see a healthcare provider. It may be an early sign of PD.

It’s also important to see a provider if:

• The tremor is getting worse over time and/or you develop other types of tremors.
• It’s affecting your daily activities.
• It’s causing you emotional distress.
• You develop other neurological symptoms, like changes in thinking, behavior or muscle strength.

If you have Parkinson’s disease, you’ll need to see your provider regularly to make sure your treatment plan is working well.