Tremor Parkinson disease-related

Tremor and akathisia are less common and can be managed with dose reduction or the addition of a P-blocker such as propranolol (10-40 mg). There are isolated case reports of SSRl-related dystonia and increasing reports of SSRl-related exacerbation of Parkinson s disease (Di Rocco et al. 1998 Linazasoro 2000). The advisability of SSRl use in depressed patients with Parkinson s disease remains to be determined. Bupropion and electroconvulsive therapy (ECT) may be reasonable alternatives for these patients. 

Levodopa or dopamine agonists produce diverse dyskinesias as a dose-related phenomenon in patients with Parkinson s disease dose reduction reverses them. Chorea may also develop in patients receiving phenytoin, carbamazepine, amphetamines, lithium, and oral contraceptives, and it resolves with discontinuance of the offending medication. Dystonia has resulted from administration of dopaminergic agents, lithium, serotonin reuptake inhibitors, carbamazepine, and metoclopramide and postural tremor from theophylline, caffeine, lithium, valproic acid, thyroid hormone, tricyclic antidepressants, and isoproterenol. 

Gross C., Guehl D. Effect of deep brain stimulation on amplitude and frequency characteristics of rest tremor in Parkinson s disease. Thalamus Relat Syst, 2001,... 

The differential diagnosis includes idiopathic torsion dystonia, parkinsonism, idiopathic torticollis, Huntington s disease, Wilson s disease, and Meige s syndrome (blepharospasm, oromandibular dystonia). A retrospective evaluation of the records of patients with idiopathic cervical dystonias (n = 82) and tardive cervical dystonias (n = 20) has been performed, in a search for clinical features that could help separate these closely related disorders (332). Despite the overall similarity, the presence of a dystonic head tremor was strongly suggestive of the idiopathic form, which was present in 42% and did not occur at all in the tardive group. A family history of dystonia (10%) was also exclusive to the idiopathic group. 

Clozapine has been used to treat psychosis related to Parkinson s disease (SEDA-22,57) (78). In a randomized, double-blind, placebo-controlled trial of low doses of clozapine (6.25-50 mg/day) in 60 patients (mean age 72 years) with idiopathic Parkinson s disease and drug-induced psychosis, the patients in the clozapine group had significantly more improvement after 14 months than those in the placebo group in all measures used to determine the severity of psychosis (80). Clozapine improved tremor and had no deleterious effect on the severity of parkinsonism, but in one patient it was withdrawn because of leukopenia. 

The dmg is used in all types of Parkinson s disease (po.st-enccphulitic. idiopathic, arteriosclerotic) and helps to eliminate akinesia, rigidity, and tremor. It is also used in drug-induced extrapyramidul disorders to eliminate symptoms and permit continued use of tranquilizers. Biperiden is also of value in spastic di.sorders not related to parkinsonism, such as multiple. sclerosis, spinal curd injury, and cerebral palsy. It is contraindicated in all form.s uf epilep,sy. 

Nervous system A 74-year-old man with Parkinson s disease was given tramadol 100 mg qds and his tremor worsened after 2 weeks, causing significant functional impairment [176 ]. There was rapid improvement within 2 weeks of tramadol withdrawal. The authors speculated that the mechanism of this adverse effect might be related to effects on serotonergic pathways. 

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