Last modified on Thursday, May 3 2007.
The above patient presents to his neurologist complaining of a tremor which has slowly been worsening over the course of several years. He states the tremor is symmetric, and he notices it mostly in his hands. It is worse when he's trying to do something with his hand, like eating. It sometimes causes him to spill his coffee when he's bringing the cup to his lips. His son has a similar tremor. He notices that when he "knocks back a few beers," the tremor improves. He has no complaints of other motor symptoms. He has no other medical issues, and takes no medications.
The tremor is present on exam, as shown. His exam is otherwise normal.
Which of the following medication regimens is most likely to be helpful in this patient?
Pergolide is a dopaminergic agent, and is effective against a broad spectrum of Parkinsonian symptoms. However, this patient has essential tremor, and bromocriptine has not been demonstrated to be effective in the treatment of essential tremor. (
This patient has essential tremor. The combination of levodopa and carbidopa is an effective treatment for symptoms of Parkinson disease, but is generally ineffective in the treatment of essential tremor. (
This patient has essential tremor. Meclizine is an antihistamine, and is indicated in the treatment of motion sickness and some forms of vertigo. It is not indicated for the treatment of essential tremor. (
This patient has essential tremor. Propranolol (120-320 mg in divided doses 2-3 times daily) and primidone (start at 25 mg po daily and titrate up to 50 to 350 mg po daily) have been shown to be effective treatments in 40%-50% of patients with essential tremor. (
This patient has essential tremor. Entacapone is used in the treatment of Parkinson disease, but is generally ineffective in the treatment of essential tremor. (