Tremor medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tremor}} | {{Tremor}} | ||
{{CMG}}; {{AE}} {{ZMalik}} | |||
==Overview== | ==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== | ||
Tremor is variable treatment depending on the underlying cause: | |||
*[[Essential tremor]]: | |||
**Non [[pharmacological]] [[therapy]]: [[Wrist]] [[weights]], minimizing [[stress]] and [[anxiety]] by relaxation techniques and [[biofeedback]]. Avoid substances that aggravate tremor ([[medications]], [[caffeine]]). Avoid getting in situations that might increase tremors. [[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>. | |||
**[[Pharmacological]] [[therapy]]: 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]])<ref name="pmid16800824">{{cite journal| author=Hess CW, Saunders-Pullman R| title=Movement disorders and alcohol misuse. | journal=Addict Biol | year= 2006 | volume= 11 | issue= 2 | pages= 117-25 | pmid=16800824 | doi=10.1111/j.1369-1600.2006.00017.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16800824 }} </ref>. 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]]<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>. | |||
*[[Parkinson's disease]] | |||
*[[Physiologic Tremor: | |||
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. | |||
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3]. | |||
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2]. | |||
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2]. | |||
===Disease Name=== | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | |||
{{WH}} | |||
{{WS}} | |||
[[Category: (name of the system)]] | |||
Revision as of 17:35, 27 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
Tremor is variable treatment depending on the underlying cause:
- Essential tremor:
- Non pharmacological therapy: Wrist weights, minimizing stress and anxiety by relaxation techniques and biofeedback. Avoid substances that aggravate tremor (medications, caffeine). Avoid getting in situations that might increase tremors. Alcohol does help come patients in minimizing tremor and some patients have noticed rebound worsening after the effect of alcohol fades[1].
- Pharmacological therapy: 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)[2]. 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[3].
- Parkinson's disease
- [[Physiologic Tremor:
- Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
- Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
- Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
- Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Disease Name
References
- ↑ 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.
- ↑ 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.