A 60year old male presents with tremors of both hands which are postural, symmetric, high frequency tremors. On examination his pulse rate is 58/mt, neurological examination is normal except for tremors. What is the drug of choice for treatment of this patient?
The patient is suffering from essential tremors and drug of choice is propranolol or primidone. As patient is having bradycardia, propranolol is contraindicated in this patient. Hence answer is primidone. Essential tremor is characterized by a high-frequency tremor (6-10 Hz) that predominantly affects the upper extremities. The tremor is most often manifest as a postural or action tremor and, in severe cases, can interfere with functions such as eating and drinking. It is typically bilateral and symmetric but may begin on one side and remain asymmetric. The differential diagnosis includes dystonic tremor or parkinsons disease. PD can usually be differentiated from ET because the former stops at the onset of a voluntary action and is typically associated with bradykinesia with progressive slowing of sequential movements (sequence effect), rigidity, gait and postural instability, and other parkinsonian features. Beta blockers and primidone are the standard drug therapies for ET Propranolol is usually effective at relatively low doses, but higher doses may be needed in some patients. The drug is contraindicated in patients with bradycardia or asthma. Ref Harrison 20th edition page 3132,3133
Levodopa
Propranolol
Primidone
Trihexyphenidyl
C.N.S