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Tremor-Predominant Parkinson’s Disease

Approaches To Treatment

  • Disease Management
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Abstract

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.

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References

  1. Martin WE, Lowenson RB, Resch JA, et al. Acontrolled study comparing trihexyphenidyl hydrochloride plus levodopa with placebo plus levodopa in patients with Parkinson’s disease. Neurology 1974; 24: 912–9

    Article  PubMed  CAS  Google Scholar 

  2. Koller WC. Pharmacologic treatment of parkinsonian tremor. Arch Neurol 1986; 43: 126–7

    Article  PubMed  CAS  Google Scholar 

  3. Young RR, Shahani BT. Pharmacology of tremor. Clin Neuropharm 1979; 4: 139–56

    Article  Google Scholar 

  4. Deuschl G, Lucking CH. Tremor and electrically elicited longlatency reflexes in early stages of Parkinson’s disease. In: Riederer HP, editor. Early diagnosis and preventive therapy of Parkinson’s disease. New York: Springer Verlag, 1989: 103–10

    Chapter  Google Scholar 

  5. Laihinen A, Rinne UK, Suchy I. Comparison of lisuride and bromocriptine in the treatment of advanced Parkinson’s disease. Acta Neurol Scand 1992; 86: 593–5

    Article  PubMed  CAS  Google Scholar 

  6. Mizuno Y, Kondo T, Narabayashi H. Pergolide in the treatment of Parkinson’s disease. Neurology 1995; 45: 513–21

    Article  Google Scholar 

  7. Pahwa R, Koller WC. Dopamine agonists in the treatment of Parkinson’s disease. Cleve Clin J Med 1995; 62: 212–7

    PubMed  CAS  Google Scholar 

  8. Pezzoli G, Martignoni E, Pacchetti C, et al. Pergolide compared with bromocriptine in Parkinson’s disease: a multicenter, crossover, controlled study. Mov Disord 1994; 9: 431–6

    Article  PubMed  CAS  Google Scholar 

  9. Pezzoli G, Martignoni E, Pacchetti C, et al. A crossover, controlled study comparing pergolide with bromocriptine as an adjunct to levodopa for the treatment of Parkinson’s disease. Neurology 1995; 45: S22–7

    Article  PubMed  CAS  Google Scholar 

  10. Corbin KB. Trihexyphenidyl: evaluation of the new agent in the treatment of parkinsonism. JAMA 1949; 141: 377–82

    Article  CAS  Google Scholar 

  11. Cantello R, Riccio A, Gilli M, et al. Bornaprine vs placebo in Parkinson disease: double-blind controlled cross-over trial in 30 patients. Ital J Neurol Sci 1986; 7: 139–43

    Article  PubMed  CAS  Google Scholar 

  12. Piccirilli M, D’Alessandro P, Testa A, et al. Bornaprine in the treatment of Parkinsonian tremor. Riv Neurol 1985; 55: 38–45

    PubMed  CAS  Google Scholar 

  13. Bonuccelli U, Ceravolo R, Salvetti S, et al. Clozapine in Parkinson’s disease tremor: effects of acute and chronic administration. Neurology 1997; 49: 1587–90

    Article  PubMed  CAS  Google Scholar 

  14. Jansen EN. Clozapine in the treatment of tremor in Parkinson’s disease. Acta Neurol Scand 1994; 89: 262–5

    Article  PubMed  CAS  Google Scholar 

  15. Freidman JH, Lannon MC. Clozapine-responsive tremor in Parkinson’s disease. Mov Disord 1990; 5: 225–9

    Article  Google Scholar 

  16. Stromberg V, Svensson TH. Furher studies on the mode of action of amantadine. Acta Pharmacol Toxicol 1971; 30: 161–71

    Article  CAS  Google Scholar 

  17. Von Voigtlander PF, Moore KE. Dopamine release from the brain in vivo by amantadine. Science 1971; 174: 408–10

    Article  Google Scholar 

  18. Fahn S, Isgreen W. Long term evaluation of amantadine and levodopa combination in parkinsonism by double-blind crossover analyses. Neurology 1985; 25: 695–700

    Article  Google Scholar 

  19. Butzer JF, Silver DE, Sahs AL. Amantadine in Parkinson’s disease. Neurology 1975; 25: 603–6

    Article  PubMed  CAS  Google Scholar 

  20. Biary N, Koller W. Kinetic predominant essential tremor: successful treatment with clonazepam. Neurology 1987; 37: 471–4

    Article  PubMed  CAS  Google Scholar 

  21. Loeb C, Priano A. Preliminary evaluation of the effects of clonazepam on parkinsonian tremor. Eur Neurol 1977; 15: 143–5

    Article  PubMed  CAS  Google Scholar 

  22. Koller WC, Herbster G. Adjuvant therapy of parkinsonian tremor. Arch Neurol 1987; 44: 921–3

    Article  PubMed  CAS  Google Scholar 

  23. Foster NL, Newman RP, LeWitt PA, et al. Peripheral beta-adrenergic blockade treatment of parkinsonian tremor. Ann Neurol 1984; 16: 505–8

    Article  PubMed  CAS  Google Scholar 

  24. Findley LJ, Cleeves L, Calzetti S. Long-term use of propranolol in essential tremor. In: Marsden CD, Benecke R, editors. Motor disorders I. London: Academic Press, 1986: 232–41

    Google Scholar 

  25. Yoshii F, Shinohara Y, Takeoka T, et al. Treatment of essential and parkinsonian tremor with Nipradilol. Intern Med 1996; 35: 861–5

    Article  PubMed  CAS  Google Scholar 

  26. Olson WL, Gruenthal M, Mueller ME, et al. Gabapentin for parkinsonism: a double-blind, placebo-controlled, crossover trial. Am J Med 1997; 102: 60–6

    Article  PubMed  CAS  Google Scholar 

  27. Scott AB. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc 1981; 79: 734–70

    PubMed  CAS  Google Scholar 

  28. Jancovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med 1991; 324: 1186–94

    Article  Google Scholar 

  29. Pullman SL, Greene P, Fahn S, et al. Approach to the treatment of limb disorders with botulinum toxin A: experience with 187 patients. Arch Neurol 1996; 53: 617–24

    Article  PubMed  CAS  Google Scholar 

  30. Trosch RM, Pullman SL. Botulinum toxin A injections for the treatment of hand tremors. Mov Dis 1994; 9: 601–9

    Article  CAS  Google Scholar 

  31. Henderson JM, Ghika JA, Van Melle G, et al. Botulinum toxin A in non-dystonic tremors. Eur Neurol 1996; 36: 29–35

    Article  PubMed  CAS  Google Scholar 

  32. Kelly PJ, Gillingham FJ. The long-term results of stereo-taxic surgery and L-dopa therapy in patients with Parkinson’s disease: a 10-year follow-up study. J Neurosurg 1980; 53: 332–7

    Article  PubMed  CAS  Google Scholar 

  33. Jankovic J, Cardoso F, Grossman RG, et al. Outcome after stereotactic thalamotomy for Parkinsonian, essential, and other types of tremor. Neurosurgery 1995; 45: 1743–46

    CAS  Google Scholar 

  34. Tasker RR. Movement disorders. In: Apuzzo MLJ, editor. Brain surgery: complication avoidance and management. New York: Churchill Livingstone, 1993: 1509–24

    Google Scholar 

  35. Vitek JL, Bakay RAE, Delong MR. Posteroventral pallidotomy for Parkinson’s disease. In: Obeso JA, editor. The basal ganglia and surgical treatment of Parkinson’s disease: advances in neurology. Vol 74. Philadelphia: Lippincott, 1997: 183–98

    Google Scholar 

  36. Fazzini E, Dogali M, Sterio D, et al. Stereotactic pallidotomy for Parkinson’s disease: a long-term follow-up of unilateral pallidotomy. Neurology 1997; 48: 1273–7

    Article  PubMed  CAS  Google Scholar 

  37. Kishore A, Turnbull IM, Snow BJ, et al. Efficacy, stabililty and predictors of outcome of pallidotomy for Parkinson’s disease: six month follow-up with additional one year observation. Brain 1997; 120: 729–38

    Article  PubMed  Google Scholar 

  38. Lozano AM, Lang AE, Galvez-Jimenez N, et al. Effect of GPI pallidotomy on motor fuction in Parkinson’s disease. Lancet 1995; 346: 1383–7

    Article  PubMed  CAS  Google Scholar 

  39. Taha JM, Fauvre J, Baumann TK, et al. Tremor control after pallidotomy in patients with Parkinson’s disease: correlation with microrecording findings. J Neurosurg 1997; 86: 642–7

    Article  PubMed  CAS  Google Scholar 

  40. Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 1996; 84: 203–14

    Article  PubMed  CAS  Google Scholar 

  41. Krack P, Benazzouz A, Pollak P, et al. Treatment of tremor in Parkinson’s disease by subthalamic nucleus stimulation. Mov Disord 1998; 13: 907–14

    Article  PubMed  CAS  Google Scholar 

  42. Pahwa R, Wilkinson S, Smith D, et al. High frequency stimulation of the globus pallidus for the treatment of Parkinson’s disease. Neurology 1997; 49: 249–53

    Article  PubMed  CAS  Google Scholar 

  43. Gross C, Rougier A, Guehl D, et al. High frequency stimulation of the Globus Pallidus internalis in Parkinson’s disease: a study of seven cases. J Neursurg 1997; 87: 471–98

    Article  Google Scholar 

  44. Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol 1998; 49: 145–53

    Article  PubMed  CAS  Google Scholar 

  45. Young RF. Functional neurosurgery with the Leskell Gamma knife. Stereotact Funct Neurosurg 1996; 66: 19–23

    Article  PubMed  CAS  Google Scholar 

  46. Duma CM, Jacques DB, Kopyov OV, et al. Gamma knife radio-surgery for thalamotomy in Parkinsonian tremor: a five-year experience. J Neurosurg 1998; 88: 1121–2

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University of Florida, 655 West 8th St, Jacksonville, Florida, 32209, USA

    Jill Marjama-Lyons

  2. Department of Neurology, University of Miami, Miami, Florida, USA

    William Koller

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  1. Jill Marjama-Lyons
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  2. William Koller
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Correspondence to Jill Marjama-Lyons.

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Marjama-Lyons, J., Koller, W. Tremor-Predominant Parkinson’s Disease. Drugs & Aging 16, 273–278 (2000). https://doi.org/10.2165/00002512-200016040-00003

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  • DOI: https://doi.org/10.2165/00002512-200016040-00003

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