El Titremesi Ciddi Sorunlara İşaret Ediyor Olabilir

El titremesi günlük yaşantımızda zaman zaman karşımıza çıkabiliyor. Bu durum çoğu zaman gergin, stresli olduğumuz anlarda ya da kahve ile çayı fazla tükettiğimiz günlerde yaşanıyor. Kullandığımız ilaçların bazıları da el titremesine neden olabiliyor. Bunları çoğu zaman geçici durumlar olduğunu düşündüğümüz için önemsemeyebiliyoruz. Ancak el titremesi hafife alınabilecek bir durum değil. Yeditepe Üniversitesi Koşuyolu Hastanesi Nöroloji uzmanı Doç. Dr. Burcu ÖRMECİ, ellerdeki titremenin önemli nörolojik hastalıkların ilk belirtisi olabildiğine işaret ediyor.

Yeditepe Üniversitesi Koşuyolu Hastanesi Nöroloji uzmanı Doç. Dr. Burcu ÖRMECİ

Bilimsel adı “tremor” olan titreme, istemsiz oluşan, ritmik, sallanma şeklindeki bir eklem hareketi olarak tanımlanıyor. Dolayısıyla sadece ellerde değil, kollarda, başta, bacaklarda ve ses tellerinde de görülebiliyor. Bazen yoğun stres altında ya da tiroit hormonunun artmasına bağlı olarak ortaya çıkabilen ellerdeki titreme sorunu altta Parkinson gibi çok daha ciddi nörolojik sorunlara da işaret edebiliyor. Bu nedenle hiçbir titremenin küçümsenmemesi ve ‘zamanla geçer’ diye düşünmeden dikkate alınması gerektiğine dikkat çekiyor.

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Basit bir titreme gibi görünen bu sorunun birçok nedeni olmakla birlikte sıklıkla; stres, korku, hipertiroidizm ya da hipokalsemi (vücutta kalsiyum miktarının azalması) gibi metabolik durumlar ile bazı ilaçlar ve uyarıcılara bağlı olarak geliştiği görülüyor. Bununla birlikte Parkinson hastalığı ve bazı hareket bozukluklarının karakteristik belirtisi de ellerde ortaya çıkan titreme oluyor. Tremorun nedenleri çeşitli olduğu için görülme sıklığı da buna bağlı olarak değişiklik gösteriyor ve bu konuda net bir bilgi verilemiyor.

Yeditepe Üniversitesi Koşuyolu Hastanesi Nöroloji uzmanı Doç. Dr. Burcu ÖRMECİ

Tanı koymada hayati önem taşıyor

Nerede ya da hangi şekilde ortaya çıkarsa çıksın, el titremesi yakınması olan kişinin, buna eşlik edebilecek hastalıklar açısından değerlendirilmek amacıyla bir nöroloğa başvurması gerekiyor. Yakınmanın şiddetine ve altta yatan duruma göre bazen sadece kullanılan bir ilacın dozunu ayarlayarak bu sıkıntıyı sona erdirmek mümkün olabiliyor. Özellikle esansiyel tremor ve fizyolojik tremor kafein alımı, stres, sıkıntı ve fiziksel yorgunlukla artış gösterdiği için bunlardan kaçınmak el titremesinin azalmasını sağlayabiliyor. Ancak kimi zaman da çok önemli bir hastalığın ilk ve tek bulgusu olarak ortaya çıkan el titremesi tanı konmada hayati bir önem taşıyabiliyor.

Ellerdeki titremenin altında yatan etkenler

Yeditepe Üniversitesi Koşuyolu Hastanesi Nöroloji uzmanı Doç. Dr. Burcu ÖRMECİ

Esansiyel tremor

Genellikle her iki elde başlayan bu durum en sık rastlanan tremor türü olarak gösteriliyor ve 100 binde 350 gibi bir sıklıkla dünyada en fazla görülen hareket hastalığı olarak nitelendiriliyor. Bazı durumlarda önce tek elde başlamış bile olsa yaklaşık üç yıl içinde diğer elde de titreme başlıyor. Gündelik yaşam içinde ince motor hareketlerini gerektiren, yazı yazmak, eşyaları tutmak gibi durumlarda titreme daha belirgin bir hal alıyor. Hatta ellerdeki titremeye ses veya dil tremorunun da eşlik ettiği görülüyor. Kişiler titremenin genellikle uykuda kaybolurken stres altında arttığını belirtiyor.

Parkinson tremoru

Pankinson hastalığının karakteristik belirtisi olan bu titreme genellikle tek elde başlıyor. 60-65 yaşından sonra görülme riski artıyor. Kişinin baş ve işaret parmağı birlikte titriyor. Para saymaya benzer bir özellikte olan bu titreme çoğunlukla dinlenme sırasında ortaya çıkıyor.

Serebellar (beyincikle ilişkili) tremor

Bu titreme türünün yaşanmasında temel etken, beyinciği etkileyen damarsal, tümöral, dejeneratif ya da kalıtsal hastalıklar oluyor. Kişiler, günlük yaşam içinde asansör ya da elektrik düğmesine basmak gibi istemli bir hareket yaptıkları sırada titremenin belirgin hale geldiğini anlatıyor.

Pozisyonel tremor

Dinlenirken ya da vücudun belli bir duruşunda, hareketle ortaya çıkabilen bu titreme sadece ellerle kalmıyor, vücudun farklı yerlerinde de ortaya çıkabiliyor.

Fizyolojik tremor

Stres, korku, sıkıntı, hipoglisemi, hipertiroidi, alkolün bırakılması ve ateş gibi durumlarda gözle görülür hale gelen bu titreme türü herkeste ortaya çıkabiliyor. Titremenin salınımı, parmağın ileri geri hareketi gibi küçük yaşanıyor. Çok büyük olmuyor.

El titremesi tedavisi nedene göre belirleniyor

Titremin seyri, şiddeti ve karakteristik özellikleri nedenlerine bağlı olarak değiştiği için tedavi yaklaşımında da sorunun kaynağını belirlemek önem taşıyor. Herhangi bir ilacın yan etkisi olarak başlayan titreme dozaj düzenlenmesi ya da kullanımının durdurulması ile düzeltilebilirken, Parkinson tanısı konan kişiler için tedavi yönü buna göre belirleniyor. En sık rastlanan esansiyel tremorun tedavisinde farklı ilaç gruplardaki ilaçlardan yararlanılıyor. Öte yandan eğer titreme strese bağlı ise psikolojik destek ve stres yönetimi konusunda kişinin bilgilendirilmesi önem taşıyor. Metabolik bozukluklardan kaynaklanan tremorda ise sorunun giderilmesi tremorun da ortadan kalkmasını sağlıyor. Bazı seçilmiş vakalarda da cerrahi yöntemler uygulanabiliyor.

Yeditepe Üniversitesi Koşuyolu Hastanesi Nöroloji uzmanı Doç. Dr. Burcu ÖRMECİ

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