neurologic disorders
Tremor
Treatment of Tremor
No treatment is necessary unless symptoms are bothersome. Avoiding triggers (such ascaffeine, fatigue, sleep deprivation, drugs, and, when possible, stress and anxiety) can help prevent or reduce symptoms. Physiologic tremor is enhanced by alcohol withdrawal, by hyperthyroidism, and by use of drugs and by conditions that can cause tremor. The tremor responds to treatment of the underlying condition. Oral benzodiazepines (eg,diazepam2 to 10 mg,lorazepam1 to 2 mg,oxazepam10 to 30 mg) given 3 or 4 times a day may be useful for people with tremor and chronic anxiety, but continuous use should be avoided.Propranolol(20 to 80 mg orally 4 times a day) and other beta-blockers are often effective for tremor enhanced by drugs or acute anxiety (eg, stage fright). Propranolol20 to 80 mg orally 4 times a day (or other beta-blockers) is often effective, as isprimidone50 to 250 mg orally 3 times a day. For some patients, a small amount of alcohol is effective; however, alcohol is not routinely recommended for treatment because abuse is a risk. Second-line drugs aretopiramate25 to 100 mg orally 2 times a day andgabapentin300 mg orally 2 or 3 times a day. Benzodiazepines may be added if other drugs do not control the tremor. No effective drug is available; physical therapy (eg, weighting the affected limbs, teaching patients to brace the proximal limb during activity) sometimes helps. Treatment is treated. Levodopa is usually the treatment of choice for most parkinsonian tremors. Parkinson Disease may be considered in certain cases, but their adverse effects (decreased mental concentration, dry mouth, dry eyes, urinary retention and the possibility that they enhance tau pathology) may outweigh their benefits, particularly in older patients. Other drugs include Dopamine agonists (eg, For severe, disabling, drug-refractory essential tremor, surgical management with unilateral stereotactic thalamotomy or chronic unilateral or bilateral thalamic deep brain stimulation may be considered. Dystonic tremor may respond better to functional neurosurgery targeting the internal portion of the globus pallidus. In Parkinson disease, tremor substantially lessens after thalamic, internal globus pallidus, or subthalamic nucleus deep brain stimulation. Although these techniques are widely available, they should be used only after reasonable drug therapy has failed and only in patients who do not have substantial cognitive or psychiatric impairment. For patients with psychogenic tremor, tremor entrainment may help. This treatment refers to the change or elimination of tremor as the patient performs a voluntary rhythmical movement by the unaffected limb ( Treatment reference ). 1.Espay AJ, Edwards MJ, Oggioni GD, et al:Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor.Parkinsonism Relat Disord20 (6):647–650, 2014. Epub 2014 Mar 20. doi: 10.1016/j.parkreldis.2014.02.029 