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Diana, Scott, Paul, and others: This posting is intended to clarfy some of the questions you all voiced about tremor and PD. Since there was some confusion about the thread, I started a new thread which could easily be identified. PD is usually accompanied by tremor - the so-called resting tremor. This tremor usually (but not invariably) decreases in intensity when you do something voluntarily. Some patients with PD may also have essential or action tremor - which does not decrease when you do something voluntarily. Both types of tremor may need separate treatment. The resting tremor or PD tremor is treated with the usual drugs for PD - levodopa (Sinemet or Madopar), pergolide (Permax), pramipexole (Mirapex), or ropinorole (Requip) - as well as trihexyphenidyl (Artane) or benztropine (Cogentin). There are other drugs sometimes used less frequently. The action tremor is treated with propranolol (Inderal, a beta blocker) or with primidone (Mysoline) most often. The FDA has not approved the use of primidone specifically for tremor. Neurologists use it widely and often for essential tremor, a so-called "off-label" use for a drug. This is common practice and perfectly legal, in which drugs marketed for one purpose find utility for other purposes. The absence of tremor in a Parkinsonism does not automatically mean that the long term outlook is worse, but it should alert the Neurologist to the POSSIBILITY that the person is afflicted with one of the more unusual forms of Parkinsonism. Signs and symptoms of Parkinsonism are most often due to Parkinson's Disease, from which the word Parkinsonsim is derived. However, there are other diseases that resemble Parkinson's Disease that also cause many of the signs and symptoms of Parkinson's Disease such as rigidity, slowness, poor balance, gait problems. Some Neurologists refer to these as the "Parkinson-plus" syndromes, or the "Parkinson-look-alikes." A few of these have been mentioned in this list every so often: Progressive Supranuclear Plasy (PSP), Shy Drager Syndrome, Multiple System Atrophy, Diffuse Lewy Body Disease, Cortical-Basal-Ganglionic Degeneration (CBGD), to name a few. These are rare diseases in comparison to Parkinson's Disease. They tend to produce tremor LESS often, but produce MORE rigidity and slowness and gait problems. These diseases TEND to progress faster and are more disabling than PD, and respond less well to the medications used. That is the basis for someone stating that the absence of tremor may be a poor sign - the possibility that the afflicted person may have one of these more aggressive disorders. The diagnosis most often is made by observation and time. Most of these diseases, as they advance, develop special signs that help classify them more accurately. In practice, the treatment is the same, for the most part. I hope that clarifies most of the questions regarding tremor types and prognosis is PD. Jorge Romero, MD 3600 Gaston Avenue Dallas, Texas 75231 ----- Original Message ----- From: "Diana Sellin" <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, April 01, 2002 7:47 PM Subject: Re: Hello...I'm new here > Paul: > I do not have any tremor, so am confused about your posting. can you please > explain? Thanks, Diana > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: mailto:[log in to unmask] > In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn