The diagnosis requires knowledge of the typical movement disorders and the syndromes that can occur with different drug classes, and their typical time course. This is important because the most imperative therapeutic intervention for most drug-induced movement disorders is stopping the offending drug, with or without supportive or other pharmacological treatment. While no specific procedures are listed for medication-induced movement disorders, interventions like deep brain stimulation (DBS) may be considered in severe cases, particularly for conditions like tardive dyskinesia or Parkinson’s disease. DBS involves implanting electrodes in the brain to regulate abnormal movement signals and is typically reserved for advanced cases where medications are ineffective. As mentioned previously, resting tremor in DIP due to DBA can be asymmetric in many patients.2–5 Treatment of MIT due to DBA is aimed at reducing the dose of the offending drug or attempting to eliminate it completely. If this is not possible then anticholinergics or amantadine are often used to combat symptoms.
Who Is at Risk for Drug-Induced Tremors?
Theophylline is a drug used to treat wheezing and shortness of breath. It’s helpful to remember that pseudoparkinsonism symptoms usually resolve within weeks to months after discontinuing the drug that is causing them. Work closely with your neurologist to address your symptoms and connect with a support network during your recovery process.
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Sometimes drug-induced parkinsonism symptoms continue even after the medication has been discontinued. Finally, it will be important to further define the most vital anatomical structures for the generation of tremor in the CNS and further understand the physiology of these interconnected players. It will also be important to develop further knowledge of neurotransmitters and their receptors that may influence tremor or actually suppress it. Hopefully this further knowledge will lead to better therapeutics for pathological tremors and allow us to develop less tremorogenic drugs. The altered mental status, autonomic instability, and spasticity or rigidity with raised creatine kinase, overlap with neuroleptic malignant syndrome.
Mechanisms of Medication-induced Tremor for More Common Offending Agents
When tremor occurs during activities and there is no anatomic, emotional, or chemical cause, it can be a sign of a neurological disease called essential tremor. Have you ever wondered how often abnormal involuntary movements (AIMs) develop following use of medications? Have you been unsure about which aspects of the history, physical examination, and laboratory tests are most likely to yield meaningful information about the etiology and treatment of drug-induced abnormal movements? If so, then the following case vignette and discussion should prove useful.
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- In serotonin syndrome the onset is hyperacute, within hours rather than days, and the signs of central nervous system hyperexcitability are more prominent.
- You might want to go to a support group while you wait for your symptoms to subside.
- Your doctor will diagnose the cause of your tremor based on your medical history, physical exam, and blood tests.
- Drinking caffeinated beverages, like coffee and certain teas or sodas, can make your tremors worse.
Your health care provider can make the diagnosis by performing a physical exam and asking about your medical and personal history. Drinking caffeinated beverages, like coffee and certain teas or sodas, can make your tremors worse. Tremors aren’t life-threatening, but they may be embarrassing for you if they happen in public. You might want to go to a support group while you wait for your symptoms to subside.
Common Medications That Can Cause Tremors
Should the offending drug need to be continued, discuss the risks of the adverse effects versus the benefits of continuing to ensure the patient is informed. If the drug is continued, drugs typically used for essential tremor (for example, propranolol) can occasionally be beneficial. Like most commonly abused drugs, opioids raise dopamine levels by blocking the inhibitory gamma-aminobutyric acid (GABA). Dopamine abuse may result in restless leg syndrome (RLS) and tremors. While resting tremors are common in patients with Parkinson’s disease, they are not as common in pseudoparkinsonism. This is one way to tell the two conditions apart during the diagnostic process.
Intermittent apomorphine drug induced tremors injections or a continuous infusion may be required in moderate– severe cases. These tests can identify other medical conditions that can cause similar symptoms. If any of these conditions are causing your tremor, you do not have essential tremor.
Virtual consultations provide timely medical advice, prescription adjustments, and follow-up care without the need for in-person visits, which is especially helpful for those with mobility issues or living in remote areas. The progression of medication-induced movement disorders varies depending on the drug and the duration of use. Some symptoms may appear within days or weeks of starting a medication, while others may take months or even years to develop. In some cases, symptoms may persist even after the medication is discontinued. Tremors can occur in the setting of withdrawal states, especially with benzodiazepines, ethanol, and opiates. One well-performed study found that patients undergoing ethanol withdrawal had tremors in the range of 8–12 Hz.74 When patients abruptly stop β-adrenergic antagonists such as propranolol, an increase in action and postural tremor can be observed as well.
Age and genetics play a significant role in the development of medication-induced movement disorders. Older adults are more susceptible to these conditions, as the body’s ability to metabolize and eliminate medications decreases with age. This can lead to higher drug levels in the bloodstream, increasing the risk of side effects. Additionally, some individuals may have a genetic predisposition to developing movement disorders. For example, certain genetic variations can affect how the brain responds to medications, making some people more vulnerable to developing MIMDs.
Often, the tremors occur when a person dependent on alcohol stops taking alcohol. On the other hand, hypokinetic disorders are characterized by lack or absence of movement due to weakness. Ask your provider if it is OK to take over-the-counter medicines that contain stimulants or theophylline.
Essential tremor is most noticeable when your body is in action, such as when you are writing, typing, or pouring a beverage. In contrast, the tremors of Parkinson’s are more noticeable at rest. More Than Rehab offers high-quality, individualized treatment to anyone struggling with addiction. Additionally, we treat any co-occurring disorders to improve your quality of life. If you believe you or your loved one’s movement disorder results from drug use, it is best to seek professional help. A professional drug rehabilitation program will help by offering advice, providing a correct diagnosis, or discussing treatment options.
In serotonin syndrome the onset is hyperacute, within hours rather than days, and the signs of central nervous system hyperexcitability are more prominent. For severe symptoms, your doctor may discuss injections of botulinum toxin (Botox) or very special surgical procedures such as deep brain stimulation (implantation of electrodes into the brain). These are generally reserved for severe tremors that don’t respond to other therapies. People sometimes worry that essential tremor is the start of Parkinson’s disease.
A physical and neurologic examination revealed no additional abnormalities. Depending on the duration of dyskinesia, the levodopa dose can usually be reduced to a lower dose which still maintains efficacy. It is worth noting that mild dyskinesias are often not bothersome to the individual and do not interfere with their function, therefore a change in levodopa dose may not be required. Referral is recommended for patients with late-stage disease for consideration of device-assisted therapy. Essential tremor is different than Parkinson’s disease, another neurological illness.
Some of these treatments are within the scope of practice of primary care physicians; others will require referral to specialists. The tremor caused by medicine can affect various body parts such as the eyelids, head, arms, hands, and voice. These drugs are used in patients after organ transplants to prevent the rejection of the transplanted organs. Many patients have experienced tremors with immunosuppressants, especially when the serum drug level is high. The mainstay of treatment includes resuming anti-parkinsonian drugs, usually via nasogastric tube because of the dysphagia resulting from severe parkinsonism.
Unfortunately, the tremors may also indicate a more serious underlying issue. Alcohol tremors are a symptom of Wernicke-Korsakoff Syndrome, a medical condition that can easily result in death. Alcohol tremors primarily affect the hands, but they affect the legs and arms in some circumstances. The tremors manifest approximately 8 hours after you stop drinking and peak about 30 hours after your last drink. Alcohol abuse may result in alcohol shakes, also called jitters or tremors.
Your body’s dopaminergic system affects various processes, including movement control and cognition. Therefore, when cocaine increases your extracellular dopamine levels, your dopamine levels significantly decrease, affecting your motor function. Patients who experience a full recovery are considered to have true drug-induced parkinsonism. If you or a loved one continue to experience symptoms or recover but later develop the symptoms again, you may be considered to be in the early stages of parkinsonism or Parkinson’s disease. Because drug-induced parkinsonism is caused by a medication, treatment usually involves identifying and then slowly discontinuing the drug. Studies have shown that the severity of drug-induced parkinsonism is related to the severity of the cognitive symptoms.
Rarely a medicine like propranolol, used to treat essential tremor, may be prescribed to control a medication-induced tremor. Treatments like deep brain stimulation and surgery are usually reserved for severe tremors that do not respond to other therapies. Even though antihypertensive agents are not the most concerning drug class when it comes to tremors, some medications used to treat high blood pressure, such as aliskiren and amlodipine, have been linked to drug-induced tremors. Talk to your doctor if you notice symptoms of tremors while on medication for high blood pressure.
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