1 April 2000
Marjama-Lyons J. and Koller W.
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.
