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A 68-year-old man presents to your office for evaluation of tremor. He has had this problem for 3 years and it is beginning to affect his work. He has difficulty writing and has begun to notice wavering in his voice when dictating letters (now his preferred method of correspondence). He denies having any history of regular alcohol consumption but keeps a bottle of scotch in his desk because it “steadies his nerves” before important meetings. On examination, he has a relatively fast tremor of the right hand that is enhanced significantly with finger-to-nose testing. His voice has a shaky, quivering quality. His gait is normal, but his handwriting is very difficult to read because of shaking when he writes.

Which of the following medications is most likely to help this patient?
A. Carbidopa-levodopa
B. Valproic acid
C. Selegiline
D. Amitriptyline
E. Propranolol

E..

agree with MK.

MKJS.

E: propranolol

E

This patient’s fast tremor that increases with intention and involves his voice is most likely
caused by essential tremor. Parkinson symptoms typically decrease with intention, and
although it can involve facial and jaw muscles, the disease usually spares phonation.
Alcohol consumption often briefly suppresses symptoms of essential tremor, and beta
blockers can prove to be helpful in long-term therapy. Essential tremor does not typically
respond to antiparkinsonian agents, and tricyclic antidepressants or valproate can worsen
the problem. (Answer: E—Propranolol)