The treatment of primary tremor is divided into medication and surgery. The principles of pharmacological treatment are: (1) mild tremor does not require treatment; (2) patients with mild to moderate tremor may choose to take medication half an hour beforehand to temporarily reduce symptoms due to work or social needs; Zhang Yuqing, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University (3) moderate to severe tremor that affects daily life and work may choose surgical treatment; (4) propranolol, and (4) Propranolol (propranolol), and paracetamol are the drugs of choice for treatment. (2) Surgical treatments include disruptive surgery and deep brain electrical stimulation (also called pacemakers), both of which are good treatments for tremor compared to drugs. The brain pacemaker has the characteristics of reversibility and modifiability, and can be operated bilaterally at the same time. Drug selection 1. Propranolol: a non-selective adrenergic beta-blocker, a classical first-line therapeutic drug. (1) Usage: Start with a small dose (10 mg/d twice a day) and gradually increase the dose (5 mg/d) to 30-60 mg/d to have symptomatic improvement, usually not more than 90 mg/d
The standard tablet is taken orally three times a day, and the controlled-release tablet is taken once a day in the morning. (2) Efficacy: It can effectively reduce the amplitude of limb tremor by 50% (frequency is not reduced), but it is less effective for axial tremor (such as head, voice, etc.). (3) Adverse effects: Most of the side effects are the corresponding adrenergic β-blocking effects, common pulse rate reduction and blood pressure drop, but more than 60 times/min heart rate is basically tolerated, should be closely observed during the use of heart rate and blood pressure changes, such as heart rate <60 times/min can be considered to reduce the dose, <55
If the heart rate is less than 60 beats/min, consider reducing the dose, and stop the drug if it is less than 55 beats/min. (4) Relatively contraindicated in unstable cardiac insufficiency, high atrioventricular block, asthma, insulin-dependent diabetes mellitus, etc. 2, primidone (primidone) is a commonly used anti-epileptic drugs. (1) Usage: generally start with 25 mg per night, gradually increase the dose 25 mg/time, the effective dose is 50-500 mg/d, generally 250 mg/d
It is highly effective and well tolerated. To reduce the side effects of drowsiness, it is recommended to take the drug at night before bedtime. (2) Efficacy: Significantly effective in hand tremor, reducing the amplitude of tremor by 50%. (3) adverse reactions: in the early stage of drug use, the incidence of acute side effects (including dizziness, nausea, vomiting, walking instability, drowsiness, acute toxic reactions, etc.) is relatively high, most of the adverse reactions will gradually reduce the flesh after a few days or reach tolerance. 3, clonazepam (clonazepam) is a benzodiazepine preparation. (1) Usage: The starting dose is 0.5 mg/d, and the effective therapeutic dose is 1- 6 mg/d. (2) Efficacy: It can effectively reduce the amplitude of motor tremor. (3) Adverse effects: dizziness, unstable walking, excessive sedation, etc. Drug dependence may occur with long-term use.