Re: Tremor and PD

[Jorge Romero MD <romero.jorge@xxxxxxxxxxxxxxxx>]

Julie:

If the tremor is a resting tremor, and the diagnosis is PD, treatment with
propranolol is unlikely to help.  Since the tremor is a problem, it would
seem that a trial of one of the anti-PD meds (levodopa, pramipexole,
ropinirole, or pergolide) would be rational.

Given the situation you describe, a visit to a neurologist, movement
disorder specialist, or PD specialist would be advisable.

Jorge A Romero, MD
3600 Gaston Ave
Wadley Tower Suite 455
Dallas, Texas 75246


----- Original Message -----
From: "winddam" <winddam@xxxxxxxxxxx>
To: <PARKINSN@xxxxxxxxxxxxxxxxxxxx>
Sent: Thursday, April 04, 2002 6:07 AM
Subject: Re: Tremor and PD


> Dear Dr Jorge
>
> My husband has been struggling for the past 3 years to maintain a valid
and
> credible professional life whilst plagued by tremor, which to most
observers
> suggests senility and incompetence. He is a professional Chartered
Engineer,
> engaged in research and development, so you can appreciate the impression
> created by the tremor is career damaging.  We live in Devon, UK.
> Medical advice we have received, whilst caring and sympathetic, offers no
> medication, apart from propanolol, and no alternatives, in fact nothing
but
> cope as best you can for the time being, then retire, and line up a good
> carer!
> This passivity is alien to us and I have just begun to research the
subject
> with the view to finding other attitudes, other alternatives, hence my
> subscription to PARKSN
> The information in your message would have been welcome to us before, and
it
> also seems from what you say that propanolol, which is the only medication
> that has been offered, is not appropriate for resting tremor.  My husband
> has a pronounced resting tremor but no action tremor at all - he can still
> do very intricate manual work with no loss of dexterity. He has no
rigidity,
> slowness, nor gait problems, indeed no problem at the moment except the
> tremor, but this is now spreading and becoming worse.
> The diagnosis of Parkinson's disease was made by our local GP, and
confirmed
> by a General Consultant Physician.  He has never been referred to a
> neurologist and this is the first question I need to answer. It seems to
me
> that three years is enough time to "wait and see".  Is it possible you
would
> be able to indicate for me what would be considered best practice in
> diagnosis?  Should there be a referral to a neurologist?  Also would you
> have any comment to offer on medication?
>
> Sincerely
>
> Julie Trevithick
>

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