Benign Tremoulos Parkinsons

[attyj]

Anyone familiar with "Benign tremoulos parkinsons?"

[Hidden]

I learned something today, thank you. translationalneurodegenerat...

Question, Do I have BTP? Answ: “require further studies” but maybe I do.

BTP is relatively new, therefore lacks clinical validity and specific diagnostic criteria. In the early stages, it maybe difficult to clinically differentiate BTP from typical idiopathic PD. If there is dopamine depletion in the brain, the patient is likely to suffer from PD [28]. The clinicians should consider BTP if the patients present with prominent rest tremor in conjunction with postural and action tremors. BTP becomes very likely if tremor remains the major sign/symptom with mild and stable Parkinsonism despite several years of follow-up. The other clinical clues include the absence of a satisfactory response to levodopa therapy and a positive family history. A Dopamine transporter Single-photon emission computed tomography (DAT SPECT) test which is sensitive and specific for diagnosis of degeneration related parkinsonism has not been reported in BTP, may be helpful for diagnosis. If BTP is distinct from tremor predominant PD, DAT SPECT is expected to be normal [36].

Treatment

BTP patients have usually shown refractoriness to levodopa therapy, particularly in the early disease stages, despite reaching average doses of 900 mg/day [21, 40]. Selikhova et al. [41] found that in a series of 12 patients, six patients had a transient early response to high doses of levodopa (400–1250 mg/day), and over half of the patients did not have a satisfactory response to dopaminergic therapy [41]. Interestingly, substantial levodopa complications including dyskinesias have not been described in these patients. The effect of medications other than levodopa, particularly the neuroprotective agents [8, 31] and anti-tremor medications, on the course and tremor symptoms in these patients require further studies.

BTP is clinically characterized by asymmetric tremors at onset, tremors present at rest, postural and action tremors and they remain as the prominent clinical feature for many years. These tremors donot respond to alcohol. Tremors are accompanied by other mild features of parkinsonism which do not progress at typical rates. Unlike typical PD, there family history is significant and the nonmotor features are not that frequent. Autopsy studies have found fewer pathological changes in the substantia nigra. Whether BTP is a distinct clinical entity or is a subtype of PD is currently debatable. Treatment of BTP is challenging, response to levodopa is poor even when tried at high doses. Athough small scale studies have shown bilateral DBS of VIM and STN to exhibit excellent outcomes, prospective studies with larger sample sizes, and randomized target selection, are required to determine the long-term efficacy and durability

[attyj in reply to Hidden]

This is my diagnosis per neurologist. Tremors started 6 years ago. Still on the mild side.

[Hidden in reply to attyj]

I read elsewhere that the first five years are fine and decline then begins to be more serious. I'm just now going into my fifth year. It is also reported the neurologist can forecast your future after that first five years. 6 years and still mild is good news. I have much hope for my future.

[Hikoi]

Thanks attyj and Roy

Thisi is very interesting. Could it explain the claims some make to have reversed their symptoms.?

[Hidden in reply to Hikoi]

I have hope some have actually reversed or stopped/slowed progression. If they did I would expect to read about many others. For now, I believe exercise is critical.