Tremor medical therapy: Difference between revisions
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**Third line [[medications]] include [[nimodipine]] and [[clozapine]]<ref name="pmid15972843">{{cite journal| author=Zesiewicz TA, Elble R, Louis ED, Hauser RA, Sullivan KL, Dewey RB | display-authors=etal| title=Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. | journal=Neurology | year= 2005 | volume= 64 | issue= 12 | pages= 2008-20 | pmid=15972843 | doi=10.1212/01.WNL.0000163769.28552.CD | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15972843 }} </ref>. [[Alcohol]] does help come [[patients]] in minimizing tremor and some [[patients]] have noticed rebound worsening after the effect of [[alcohol]] fades<ref name="pmid20451458">{{cite journal| author=Louis ED| title=Essential tremor: evolving clinicopathological concepts in an era of intensive post-mortem enquiry. | journal=Lancet Neurol | year= 2010 | volume= 9 | issue= 6 | pages= 613-22 | pmid=20451458 | doi=10.1016/S1474-4422(10)70090-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20451458 }} </ref>. | **Third line [[medications]] include [[nimodipine]] and [[clozapine]]<ref name="pmid15972843">{{cite journal| author=Zesiewicz TA, Elble R, Louis ED, Hauser RA, Sullivan KL, Dewey RB | display-authors=etal| title=Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. | journal=Neurology | year= 2005 | volume= 64 | issue= 12 | pages= 2008-20 | pmid=15972843 | doi=10.1212/01.WNL.0000163769.28552.CD | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15972843 }} </ref>. [[Alcohol]] does help come [[patients]] in minimizing tremor and some [[patients]] have noticed rebound worsening after the effect of [[alcohol]] fades<ref name="pmid20451458">{{cite journal| author=Louis ED| title=Essential tremor: evolving clinicopathological concepts in an era of intensive post-mortem enquiry. | journal=Lancet Neurol | year= 2010 | volume= 9 | issue= 6 | pages= 613-22 | pmid=20451458 | doi=10.1016/S1474-4422(10)70090-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20451458 }} </ref>. | ||
*[[Parkinson's disease]] | *[[Parkinson's disease]] | ||
*[[Physiologic Tremor: | *[[Physiologic Tremor]]: | ||
*[[Multiple Sclerosis]]: | *[[Multiple Sclerosis]]: | ||
**[[Beta-blockers]], [[anxiolytics]], [[anticonvulsants]] can help minimize MS-related tremors. | **[[Beta-blockers]], [[anxiolytics]], [[anticonvulsants]] can help minimize MS-related tremors. | ||
Revision as of 01:13, 28 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
The mainstay of treatment for tremor is to recognize the type of tremor and underlying etiology and then treat is appropriately. Tremor cannot be cured but it can be managed optimally with indicated medications.
Medical Therapy
Non-pharmacological Therapy
- These may help minimize tremor regardless of the cause. Basis of non pharmacological therapy includes:
- Lifestyle changes: Limiting tremor-provoking substances such as caffeine and medication.
- Physical therapy: Physical, speech-language, occupational therapy.
- Psychological techniques: Relaxation techniques, biofeedback.
Pharmacological Therapy
- Essential tremor:
- First line medications are propranolol (40 to 240 mg/day) or primidone (initiated at 12.5 mg daily, titrated gradually to the dose of 50 and 750 mg daily - divided into BID or TID)[1]. If not effective individually then these two medications should be tried in combination.
- Second line medications include gabapentin, pregabalin, topiramate, beta-blockers (atenolol and metoprolol), benzodiazepines (clonazepam, alprazolam).
- Third line medications include nimodipine and clozapine[2]. Alcohol does help come patients in minimizing tremor and some patients have noticed rebound worsening after the effect of alcohol fades[3].
- Parkinson's disease
- Physiologic Tremor:
- Multiple Sclerosis:
- Beta-blockers, anxiolytics, anticonvulsants can help minimize MS-related tremors.
References
- ↑ Hess CW, Saunders-Pullman R (2006). "Movement disorders and alcohol misuse". Addict Biol. 11 (2): 117–25. doi:10.1111/j.1369-1600.2006.00017.x. PMID 16800824.
- ↑ Zesiewicz TA, Elble R, Louis ED, Hauser RA, Sullivan KL, Dewey RB; et al. (2005). "Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 64 (12): 2008–20. doi:10.1212/01.WNL.0000163769.28552.CD. PMID 15972843.
- ↑ Louis ED (2010). "Essential tremor: evolving clinicopathological concepts in an era of intensive post-mortem enquiry". Lancet Neurol. 9 (6): 613–22. doi:10.1016/S1474-4422(10)70090-9. PMID 20451458.