TRIPASS XR تري باس

 

Injections

in the wrist can cause hand weakness, and dysphagia, hoarseness, and breathiness

can occur with injections into the neck or vocal cords. The use of botulinum toxin

injections in the United States is also limited by cost. Treatment should occur with

the lowest dose, and the interval should be as long as possible between injections.

DBS of the ventral intermediate nucleus of the thalamus or unilateral thalamotomy is

possibly efficacious in reducing ET.

170 Greater improvement in self-reported

measures of function and fewer adverse events make DBS the preferred surgical

option of the two.

170

Because K.H. is otherwise healthy, she is a good candidate for propranolol

therapy. Propranolol can be initiated as needed or on a scheduled basis depending on

the degree of impairment and desire of the patient. If the decision is made with K.H.

to use propranolol on an as-needed basis, she should begin with one-half of a 20-mg

tablet administered 30 minutes to 1 hour before the desired effect. The dose can be

increased from one-half to two tablets. An example of a situation in which this may

occur is whether she wants to avoid embarrassment with attending a social activity

or before certain tasks requiring manual dexterity at work. Given the degree of her

impairment, she is probably a better candidate for chronic suppressive therapy with

propranolol. In this situation, she can be prescribed 10 mg twice daily, because it can

be safely and easily up-titrated every few days to a minimally effective dose,

generally not more than 120 to 360 mg/day in divided doses.

KEY REFERENCES AND WEBSITES

A full list of references for this chapter can be found at

http://thepoint.lww.com/AT11e. Below are the key references and websites for this

chapter, with the corresponding reference number in this chapter found in parentheses

after the reference.

Key References

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(15)

Miyasaki JM et al. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in

Parkinson’s disease (an evidence-based review): report of the Quality Standards Subcommittee of the American

Academy of Neurology. Neurology. 2006;66:996.

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Pahwa R et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an

evidence-based review): report of the Quality Standards Subcommittee of the American Academy of

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PD Med Collaborative Group, Gray R et al. Long-term effectiveness of dopamine agonists and monoamine

oxidase-B inhibitors compared with levodopa as initial treatment for Parkinson’s disease (PD MED): a large,

open-label, pragmatic randomised trial. Lancet. 2014;384(9949):1196–1205. (28)

Zesiewicz TA et al. Practice parameter: treatment of non-motor symptoms of Parkinson disease: report of the

Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:924. (130)

Zesiewicz TA et al. Evidence-based guideline update: treatment of essential tremor: report of the Quality

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