Medically reviewed by Susan W. Lee, DO — Written by Erica Hersh — Updated on July 17, 2025
A pill rolling tremor is an early symptom of Parkinson’s disease. You will want to consult a doctor, because early diagnosis and treatment can help control your Parkinson’s symptoms and reduce complications.
If you have a pill rolling tremor, it looks like you are trying to roll a pill or another small object between your thumb and index finger. It’s a resting tremor, meaning that it is most likely to happen when your body is relaxed rather than when you’re using your hands.
A pill rolling tremor is one of the most common tremors associated with Parkinson’s disease. It’s usually one of the earliest symptoms.
What causes it?
Tremors are caused by problems in the parts of the brain that control movement, including the cerebellum and basal ganglia.
Some types of tremors can be inherited, Others are caused by factors such as:
- neurological disorders, such as multiple sclerosis (MS) and stroke
- excessive caffeine consumption
- an overactive thyroid
- liver or kidney failure
- anxiety, stress, and fatigue
Tremors in general are one of the major symptoms of Parkinson’s disease, occurring in approximately 75% of all cases.
In Parkinson’s disease, nerve cells in a part of the brain called the basal ganglia degenerate and produce less of a neurotransmitter called dopamine. The basal ganglia use dopamine to form connections and communicate between neurons. When there’s less dopamine, there aren’t proper connections and communication.
The basal ganglia are responsible for making sure your body movements are smooth. When there aren’t as many connections in this area of the brain, they can’t do their job as well, leading to tremors and the other movement symptoms of Parkinson’s disease.
The conditions that can cause pill rolling tremors are all serious conditions, so if you have developed a pill rolling tremor, it’s important to see your doctor as soon as possible.
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