Despite the fact that standard dopaminergic medications, such as dopamine agonists and the various forms of levodopa, will reliably relieve rigidity and bradykinesia, their effects on tremor are variable. For some people, these medications will provide excellent control of tremor, but in others, with what appear to be identical symptoms, they will seem to have little effect. These differences in responsiveness have yet to be satisfactorily explained.
In treating Parkinson’s tremor, it is appropriate to introduce anti-Parkinsonian dopaminergic medications when it is considered necessary on clinical grounds. Other anti-Parkinsonian medication may also be helpful, such as Symmetrel® (amantadine) or the older anticholinergic medications and sometimes the medications that are used for Essential Tremor (ET), especially beta blockers, can prevent the fluctuations of tremor.
Some people may also respond to deep brain stimulation (DBS) in which one or two surgically implanted medical devices called neurostimulators (similar to cardiac pacemakers) deliver electrical stimulation to precisely targeted areas on each side of the brain. The exact site for the stimulators in the brain is dependent on the overall picture of Parkinson’s symptoms, including tremor and stimulation of these areas appears to block the signals that cause the disabling motor symptoms. For ‘invasive’ treatments, such as DBS, it is essential that the patient is assessed by an experienced multidisciplinary team, consisting of a movement disorder neurologist, experienced functional neurosurgeon, a neurophysiologist and a neuro-radiologist.
Despite the fact that Parkinson’s tremors respond unpredictably to anti-Parkinsonian medications, the treatments available can make a huge difference to the quality of life to many people with Parkinson’s.
