Please answer the question for me as I have found that the probable answer "Benzhexol" is an old drug,used less nowadays."It was previously believed to be effective in tremor that was resistant toother therapies,although this is now questionable" .Neurology/medical masterclass/RCP-London.
A patient,55, with Idiopathic Parkinson's Disease,has hand tremor. Which drug is helpful for his tremor?
quote: Originally posted by: dipcho2002 "Please answer the question for me as I have found that the probable answer "Benzhexol" is an old drug,used less nowadays."It was previously believed to be effective in tremor that was resistant to other therapies,although this is now questionable" .Neurology/medical masterclass/RCP-London. A patient,55, with Idiopathic Parkinson's Disease,has hand tremor. Which drug is helpful for his tremor? 1. Benzhexol 2. Cabergoline 3. Selegiline 4. Amantadine 5.Co-Careldopa"
Dear Dr. Dipankar, Thank you. If you consider basics of treatment of parkinsonism, one would use an agent either to enhance dopaminergic activity or decrease cholinergic activity. Decreasing cholinergic activity is more effective in reduction of tremor. Out of the drugs listed benzhexol is a pure antimuscarinic( anticholinergic ) agent, amantadine has both dopaminergic activity and antimuscarinic activity although its effect is mild. The other drugs listed increase dopminergic activity. Taken in the light of this information I would think the answer to the question is benzhexol. I would be interested to know what the author of the question considered the correct answer to be? Thanks basj
The reply to this question is not simple and practice would vary among clinicians. If the diagnosis of Idiopathic Parkinson's Disease has been made with some certainty (and Essential Tremor excluded) my choice for 1st line of treatment would be a non-ergot Dopamine Agonist like Ropinirole or Pramipexole. The tremor in IPD is difficult to suppress with any available medication and a Dopamine Agonist would be beneficial in levodopa sparing.
I wouldn't have chosen any of the listed responses!
Althea
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