Tremor-predominant Parkinson's disease. Approaches to treatment.
Parkinson's disease is a neurodegenerative disorder that manifests clinically with variable degrees of tremor, muscle rigidity, bradykinesia and postural instability. Tremor-predominant Parkinson's disease is characterised by prominent tremor of one or more limbs with a relative lack of significant rigidity and bradykinesia. Despite the lack of other disabling motor symptoms, the tremor of tremor-predominant Parkinson's disease can be very disabling, especially if a postural and kinetic component exists. A wide variety of treatments for Parkinson's disease tremor are currently available and include use of oral medications, injections with botulinum toxin and neurosurgical procedures. Some of the first line medications (levodopa, dopamine agonists, anticholinergics) are very effective in controlling tremor. However, some patients with Parkinson's disease tremors are unresponsive to first line drugs and treatment with second line medications (clozapine, amantadine, clonazepam, propranolol, neurontin) should be attempted. In the small number of patients with disabling tremor that is refractory to all medications, neurosurgical intervention should be considered. Both thermocoagulation and deep brain stimulation at several different neuroanatomical sites (thalamus, globus pallidus, subthalamic nucleus) offer good to excellent tremor control with relatively low risk to the patient.
Marjama-Lyons
J
J
Department of Neurology, University of Florida, Jacksonville, USA. jm.lyons@jax.ufl.edu
Koller
W
W
D000085:Acetates / Q000627:therapeutic use; D000547:Amantadine / Q000627:therapeutic use; D000588:Amines; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids; D018491:Dopamine Agonists / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D000077206:Gabapentin; D005720:Gamma Rays; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods; D010300:Parkinson Disease / Q000188:drug therapy* / Q000601:surgery*; D011433:Propranolol / Q000627:therapeutic use; D016634:Radiosurgery / Q000295:instrumentation; D013788:Thalamus / Q000601:surgery; D014202:Tremor / Q000628:therapy; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000978:Antiparkinson Agents; D018680:Cholinergic Antagonists; D003509:Cyclohexanecarboxylic Acids; D018491:Dopamine Agonists; D005680:gamma-Aminobutyric Acid; D002998:Clonazepam; D000077206:Gabapentin; D011433:Propranolol; D000547:Amantadine; D001905:Botulinum Toxins; D003024:Clozapine