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We studied the acute and chronic effects of propranolol and primidone in essential tremor by administering long-acting propranolol(80 to 160 mg/d) and primidone(50 to 250 mg/d)to 50 patients.We evaluated patients at 1,3, 6,9,and 12 months after treatment and assessed tremor by subjective rating by patients,clinical scoring,and tremorgraphic(accelerometer)recordings. Acute adverse reactions occurred in 8%with propranolol and 32%with primidone.Propranolol was without therapeutic effect in 30%,and 32%had no benefit from primidone.Significant chronic side effects occurred in 17% taking propranolol and in 0%with primidone.Tolerance to drug effect occurred with chronic treatment in 12.5%of patients with propranolol and 13.0%with primidone.We conclude that propranolol and primidone are effective long-term treatment for some patients with essential tremor. Acute adverse reactions with primidone and side effects with chronic use of propranolol hamper therapy. |
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