Medications for essential tremor

Bottom line
Older, small randomized controlled trials (RCTs) show that propranolol reduces tremor severity (about 2 points more than placebo on 10- to 15-point scales) and leads to patients feeling “definitely better” in 64% to 100% versus 14% to 20% (placebo) at 2 to 6 weeks. Benefit is seen from 90 mg/day, with 120 to 240 mg/day most studied. Primidone and topiramate may improve function based on limited RCTs.

Author/s:

Allison Paige, Samantha S. Moe

Unhealthy alcohol use in a 65-year-old man awaiting surgery

Bethie Seay — Tue, 17 Aug 2021 05:00:00 +0000

Date Added:

August 17, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.202128

MeSH

substance withdrawal syndrome

Not surprisingly, unhealthy levels of alcohol use is associated with surgical complications. Adressing it through screening and clinical management could improve outcomes.

View

Three months before elective hip arthroplasty, a 65-yearold man with osteoarthritis presents to his family physician to discuss his alcohol consumption. His surgeon had expressed concern and advised him to speak to his family physician about decreasing his drinking before surgery. He reports drinking around 6 to 10 ounces of whiskey daily for the past 5 years. His alcohol intake increased gradually after retirement, and he now has cravings daily. He recently abstained from alcohol for 4 days while visiting family and developed irritability, tremor, nausea and headache. He has never had withdrawal seizures or delirium tremens, and he does not use any other substances. He is otherwise healthy, apart from hypertension that is controlled with perindopril. He is alarmed by his cravings, withdrawal symptoms and surgeon’s concerns, and is considering decreasing his alcohol use.

Author/s:

Brothers, T. D., Kaulbach, J., Tran, A.