Objective: A 57-year old man with hand tremor is diagnosed with Parkinson’s disease (PD) and treated with high dose levodopa (L-dopa) during last 5 years, but with low effectiveness. Was that just a Parkinson’s disease with rest tremor?

Background: During these 5 years of treatment the dosage of L-dopa has been increased gradually, but the difference wasn’t as much as it was expected. The important and interesting part of this case is that according to the patient, there was no any type of tremor before, but then we found out that patient often used alcohol. After diagnosing PD and starting L-dopa treatment he stopped using alcohol. It is possible that the essential tremor has been covered by the usage of alcohol.

Methods: During neurological examination components of essential tremor were noticed and the patient was send to Electromyography (EMG). EMG confirmed a tremor with a frequency of 12 Hz which is a typical finding in essential tremor.

Results: We gradually started to decrease the L-dopa dosage and also have added propranolol. After 6 months patient’s condition significantly improved compared to the one during levodopa-only treatment (80-90% tremor less).

Conclusions: We shouldn’t increase the medicine dosage at once, and have to think about presence of another type of tremor.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/increase-l-dopa-dosage-for-rest-tremor-or-think-about-the-essential-tremor-too/