A 56-year-old man presents for evaluation of a tremor. The patient reports that over the last 6 months he has been having tremors in both hands that appear to improve with alcohol intake. The patient denies any tremors at rest. The tremor is worsened when he reaches for his coffee cup in the cupboard each morning. The patient reports that his father appeared to be “shaky” but does not recall his exact diagnosis since he passed when the patient was very young. Physical examination demonstrates a tremor that increases in amplitude at the end of goaldirected activities (reaching for a piece of paper).
Which of the following is the medication of choice for this patient’s condition?
A. PropranololPropranolol. The patient in this question is presenting with signs and symptoms consistent with a diagnosis of essential tremor, which is inherited in an autosomal dominant fashion. The distal upper extremities are typically affected and the legs are usually not involved. The tremor increases in amplitude when the arms are outstretched. The drug of choice for essential tremor is propranolol, with clonazepam being a second-line treatment. (B) Trihexyphenidyl is an anticholinergic used in the treatment of the resting tremor seen in Parkinson disease. (C) Haloperidol is the treatment used in Huntington disease, but this disease is characterized by several symptoms including chorea and dementia that are not seen in this patient. (D) Although primidone can be used in the treatment of essential tremor, it is typically used in combination with propranolol.