Pharmacological Treatment of Tremor in Parkinson’s Disease Revisited

Pirker, Walter; Katzenschlager, Regina; Hallett, Mark; Poewe, Werner

doi:10.3233/jpd-225060

Cited by 19 publications

(4 citation statements)

References 134 publications

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“…3. Parkinson’s disease tremor: Dopaminergic medications may not be effective for PD tremor because the severity of PD rest and action tremor is not correlated to bradykinesia and the index of dopaminergic deficiency [ 115 ]. However, levodopa is still useful in some patients.…”

Section: Step 4: Do the Additional Signs Develop Over Time?mentioning

confidence: 99%

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

Panyakaew,

Phuenpathom,

Bhidayasiri

et al. 2024

Asian Biomedicine

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The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient’s disabilities.

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Section: Step 4: Do the Additional Signs Develop Over Time?mentioning

confidence: 99%

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

Panyakaew,

Phuenpathom,

Bhidayasiri

et al. 2024

Asian Biomedicine

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“… 25 As such, anti-cholinergic agents are rarely used in PD except in younger tremor dominant patients who are cognitively intact. 26 …”

Section: Role Of the Basal Forebrain Cholinergic System In Parkinson’...mentioning

confidence: 99%

The basal forebrain cholinergic system as target for cell replacement therapy in Parkinson’s disease

Björklund,

Barker

2024

Brain

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In recent years there has been a renewed interest in the basal forebrain (BF) cholinergic system as a target for the treatment of cognitive impairments in patients with Parkinson´s disease (PD), due in part to the need to explore novel approaches to treat the cognitive symptoms of the disease, and in part to the development of more refined imaging tools that have made it possible to monitor the progressive changes in the structure and function of the BF system as they evolve over time. In parallel, emerging technologies allowing the derivation of authentic BF cholinergic neurons from human pluripotent stem cells are providing new powerful tools for the exploration of cholinergic neuron replacement in animal models of PD-like cognitive decline. In this review, we discuss the rationale for cholinergic cell replacement as a potential therapeutic strategy in PD and how this approach can be explored in rodent models of PD-like cognitive decline, building on insights gained from the extensive animal experimental work that was performed in rodent and primate models in the 1980s and 90 s. Although therapies targeting the cholinergic system has so far been focused mainly on patients with Alzheimer´s disease, PD with dementia may be a more relevant condition. In PD with dementia the BF system undergoes progressive degeneration, and the magnitude of cholinergic cell loss has been shown to correlate with the level of cognitive impairment. Thus, cell therapy aimed to replace the lost BF cholinergic neurons represents an interesting strategy to combat some of the major cognitive impairments in patients with PD dementia.

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“…Em alguns casos de DP, os tremores podem persistir apesar do uso de medicamentos dopaminérgicos ou outras terapias. Atualmente, a oferta de medicamentos capazes de estabilizar os tremores de maneira duradoura é limitada, com o risco de diminuição da eficácia ao longo do tempo ou desenvolvimento de resistência ao medicamento (Pirker et al, 2023).…”

Section: Introductionunclassified

Uso De Medicamentos No Tratamento Da Doença De Parkinson E Implicações De Tratamentos Alternativos

Silva,

Pontes Neto

2024

Rev. Contemp.

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O presente estudo tem como objetivo primordial disseminar conhecimentos sobre a doença de Parkinson e as implicações dos poucos medicamentos atualmente disponíveis para seu tratamento. Há indícios de escassez de investimentos em novas pesquisas de tratamentos farmacológicos e a falta de atenção voltada para as necessidades dos pacientes afetados por essa doença neurodegenerativa. Ao abordar o Parkinson, é fundamental compreender todas as formas de terapia disponíveis, considerando que a estabilização da condição ao longo do tempo requer não apenas tratamento farmacológico, mas também outras modalidades terapêuticas. O texto explorará algumas modalidades terapêuticas para o tratamento da Doença de Parkinson, examinando tanto seus aspectos favoráveis quanto desfavoráveis, bem como potenciais desafios relacionados à adesão aos medicamentos. O tratamento dessa enfermidade demanda cuidado minucioso e requer uma abordagem empática e atenciosa. A pesquisa de artigos seleciona publicações entre 2019 e 2023 na plataforma PubMed, utilizando descritores como: Parkinson disease, treatment of tremors, cannabinoids, levodopa e deep brain stimulation. Após aplicação de critérios de inclusão e exclusão, foram selecionados 9 estudos relevantes.

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Pharmacological Treatment of Tremor in Parkinson’s Disease Revisited

Cited by 19 publications

References 134 publications

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

The basal forebrain cholinergic system as target for cell replacement therapy in Parkinson’s disease

Uso De Medicamentos No Tratamento Da Doença De Parkinson E Implicações De Tratamentos Alternativos

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