ot in md. parkinson tremors

[rossim92]

I have parkinson shake or essential tremors. doc put me on ledovpa, i can't handle it, give me indigestion or heartburn severe. for the doctors here, what else is good to help with the shakes. i had an mri and didn't show anything abnormal, they wanted another mri with radioactive dye, i said nope. trying to stay away from radioactive stuff as long as possible. im 62 yoa now and on disability for my knees and hearing. thanks.

[AJMD429]

.
There are a bunch of variants on the levodopa/carbidopa spectrum, and often careful dosing can help.

It probably isn't the case (but would be nice), but sometimes "essential benign tremor", which responds easily to beta-blockers, will be confused with Parkinsonian tremors (the Parkinsonian tremor is more 'coarse' and usually easy for physicians to distinquish, though).

There is an inhalable version of levodopa on the market, and it may not bother the stomach as much.

It might be possible to get a compounded formula with more carbidopa (which more or less cancels out the non-neurologic effects of the levodopa).

There are other agents like apomorphine (which does NOT have anything to do with 'morphine' - other than the name rhymes) which can help (and apomorphine is also used to help people who can't maintain erections long enough for orgasm to have earlier orgasm).

There are COMT and MAO inhibiting drugs, which can do well but are prone to interactions with other medications so we avoid them unless the patient isn't on much else.

The other approach would be to aggressively address the heartburn issue - perhaps with a combination of ordinary calcium carbonate antacids, pantoprazole, and sucralfate (all three together work far better than any do alone).

The new news on Parkinsonsonism is centered on 'gut microbiome' issues, and apparently shows some real promise. One of my patients is a neurologist and spoke favorably of it, although she specializes in Alzheimer's so doesn't mess with it herself.

And the ace-up-the-sleeve if it is bad enough is an implanted stimulator - kind of a 'pacemaker' for the brain - I have a patient with one and her tremors were so awful she would sometimes have trouble not falling off an exam table unless it had armrests. She had no tremor at ALL, at her visit last year for her physical. I asked her what the deal was, and she said to hand her her purse, and she'd show me. I assumed it would be a bottle of pills, but it was her DBS controller; she pushed a button (turning the deep brain stimulator off) and immediately tremor was present. She managed a smile at my amazement, but could not do much more other than that due to the tremor, as it even tended to affect her speech. She pushed the button again and within about two seconds, the tremor again ceased.

[rossim92]

thanks for the info