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Tremor 02

Topic: Pharmacology

Created on Thursday, May 3 2007 by jdmiles

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?

A) Pergolide

B) Bromocriptine

C) Entacapone

D) Primidone

E) Levodopa and carbidopa

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This question was created on May 03, 2007 by jdmiles.
This question was last modified on May 03, 2007.

ANSWERS AND EXPLANATIONS

A) pergolide

This answer is incorrect.

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. (See References)


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B) bromocriptine

This answer is incorrect.

Bromocriptine 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. (See References)


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C) entacapone

This answer is incorrect.

This patient has essential tremor. Entacapone is used in the treatment of Parkinson disease, but is generally ineffective in the treatment of essential tremor. (See References)


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D) primidone

This answer is correct.

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. (See References)


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E) levodopa and carbidopa

This answer is incorrect.

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. (See References)


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References:

1. Shannon, K.M. (2004). Movement disorders. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 2125-2168.


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pharmacology
Tremor 02
Question ID: 050307099
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 05/03/2007
Modified: 05/03/2007
Estimated Permutations: 3600