Dr Sudhir Kumar MD DM
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May 23 • 10 tweets • 3 min read
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Shaking of hands: Essential tremor (ET) or Parkinson's disease (PD)
1. Shaking of hands (tremors) are common. The usual question among patients
(and doctors) is what is the root cause- ET or PD?
Here I would highlight the clinical differences between the two.
#MedTwitter
2. ET affects both hands, whereas PD affects one hand (asymmetric ET- one hand more affected than other &
unilateral ET- affecting only one hand can rarely occur).
If tremors remain confined to one hand for >3 years, one should look for structural brain disease (unusual for
PD).
3. Tremor in ET is brought on by doing an activity (holding a cup of coffee or writing), whereas people with PD
have resting tremors.
Tremors in ET can be better seen with outstretched arms and hands.
Tremors in PD can be better seen by distracting the patient (and observing).
4. ET tremors are suppressed by alcohol intake (I wouldn't recommend this for those who don't drink).
ET tremors are made worse with anxiety or when in presence of strangers or when someone is watching the
patient.
5. Over a period of time, the severity of tremors in ET remains same or there is only mild worsening. However,
tremors in PD get worse over time.
Additional symptoms such as slowness of movements, postural imbalance, or stiffness of arms, when present, are
suggestive of PD.
6. In ET, tremors can involve head & neck, voice and jaw. Leg tremors are rare in ET.
Resting tremors in legs favor a diagnosis of PD.
#neurotwitter #Parkinsons #tremor
7. ET is more of a social problem (embarrassment for the patient), and sometime causes fear whether it is PD or
not.
ET is rarely disabling.
On the other hand, PD causes motor disability in most people, especially after 5 years of symptom onset.
8. Tremors of ET as well as PD disappear during sleep.
Positive family history is present in 50% of ET patients, as compared to only 15% in PD patients.
9. Drugs helpful in treating ET tremor: propranolol and primidone.
Drugs helpful in treating PD tremor: Levodopa, dopamine agonists, anticholinergics.
Deep brain stimulation (DBS) works in both.
10. Finally: 6-19% of patients with ET can progress to develop PD after a mean duration of 22 years. Fortunately,
ET history in patients with PD is associated with a benign prognosis with slower motor and non-motor
progression.
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Association between positive history of essential tremor and disease progression in patients with Parkinson's dise
…
https://www.nature.com/articles/s41598-020-78794-1#citeas:~:text=DOI-,https%3A//doi.org/10.1038/s41598%2D020%2D78794…
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Dr Sudhir Kumar MD DM
Dr Sudhir Kumar MD DM
Dr Sudhir Kumar MD DM
@hyderabaddoctor
@hyderabaddoctor
@hyderabaddoctor
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When medicines fail, do prayers &
who was well-controlled on medicines
risk of fatal prostate #Cancer 1.
positive frame of mind help? 1. Mr
for 2 years, presented with 2 episodes
Prostate cancer is the second
Raja to me- “Dr, I won’t die in 6
of seizures. She was lost to follow-up
commonest cancer among men (after
months. Prescribe the best medicines;
for past 14 months. On enquiry, she
lung cancer). Advancing age, positive
I am sure I’ll defeat my disease.” His
told that she had stopped medicines
family history & several genetic
mother too echoed his words- “Dr, I
prescribed by me, and had started
markers are non-modifiable risk
love my son, and will always stand by
taking Ayurvedic Rx.
factors of prostate cancer.
his side, come what may.”
#MedTwitter
2. Me: What was the name of
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Dr Sudhir Kumar MD DM
Dr Sudhir Kumar MD DM
Dr Sudhir Kumar MD DM
@hyderabaddoctor
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