Re: Essential tremor

[Robert Fink <rafink@xxxxxxxxxxxxx>]

You wrote:

>
>The man with  benign essential tremor (familial tremor) is 76 years old
and
>depressed and full of anxiety.  I would think  it a good idea to try a
mild
>tranquilizer first before saying he has PD as well.  Caution:    Older
people
>often respond badly to tranquilizers and antidepressants and can become
even
>more anxious and
>"nervous" so have to be careful with these drugs.  Even the old bromide
of
>trying a course of Sinemet to rule out or in PD can backfire  in older
>depressed people so one needs to cautiously and slowly introduce
Sinemet over
>a period of days.
>    "They" say one needs three PD symptoms - for instance, tremor,
rigidity
>and slowness - to earn a diagnosis of PD.  I've seen depressed older
persons
>without PD look like that.
>Barbara Yacos
><barbyac@xxxxxxx>
>
>

Barbara has a good idea, but please do not forget a good neurological
workup.  The symptoms could be due to another neurological condition.
At minimum, the patient should have a CT scan to rule out "normal
pressure hydrocephalus", which can also cause Parkinsonian-like
symptoms.

Best,

Bob

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Robert A. Fink, M. D., F.A.C.S.   Phone: 510-849-2555
Neurological Surgery              FAX:  510-849-2557
2500 Milvia Street  Suite 222
Berkeley, California 94704-2636
USA

E-Mail:  rafink@xxxxxxxxxxxxx
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