International Medical Journal, Vol. 20., Iss. 3, 2014, P. 12−17.
Ivano−Frankivsk National Medical University, Ukraine
City Clinical Hospital No. 1, Ivano−Frankivsk, Ukraine
Parkinson's disease and essential tremor are the diseases in clinical picture of which tremor occurs most frequently. The diagnosis for prescription of correct treatment is sometimes difficult in clinical practice despite the availability of existing clinical criteria for essential tremor and recommendations for its treatment. The aim of the study was to determine the differential diagnostic markers of Parkinson's disease and essential tremor with the definition of the safest effective treatment strategy with application of Propranolol or Topiramate. Using clinical scale for the diagnosis of the disease, essential tremor was diagnosed in 42 patients and Parkinson's disease in 18 patients. Detailed characteristics of tremor and other clinical signs of the diseases were given. In the group of patients (24 patients) with essential tremor who were administered Propranolol in a dose of 120−240 mg/day, tremor decreased significantly in 75 % of cases, but with the dose titration after 5 days − 8 months side−effects (hypotension, bradycardia) appeared in 82 % of cases. Two men refused from the use of the drug due to possible side−effects described in the drug leaflets (impotence). The 16 patients were invited to go to a group of patients who were administered Topiramate in a dose of 25−125 mg (total 34 patients). At the beginning of treatment attention disorders and lethargy were observed in 18 % of cases; 4 (11 %) patients refused from the treatment, considering the discomfort of constant drug use was greater than that of the tremor. The older the patients were, the lower dose was required for positive effect. 6−12 months after the treatment beginning a positive effect of Propranolol without side−effects was observed in 33 %, and with Topiramate it was in 85 % of cases. Thus, the efficacy of both drugs is evident, but Tpiramate in a dose of 25−100 mg is more effective and safer.
Key words: tremor, essential tremor, treatment, topiramat.