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Had transient ischemic attack. On beta blocker. Not getting cure. CT scan, MRI normal. Prognosis?

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Posted on Sat, 13 Apr 2013
Question: My dad had a TIA incedent earlier in the year (Jan/Feb) and now has resting tremors in his right hand and leg. He can still work out and tries to do so at the gym about 3 times per week, and I beleive his doctor has him on a beta blocker, however, the tremors seem to be getting worse. Certainly they have not subsided since the medication and me and my Mom are worried. He has only seen his General Physician but no neurologist etc. When diagnosed with the TIA he spent a couple of days in the hospital and they ran CAT scan as well as MRI, both showing nothing remarkable. Any advice?
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Answered by Dr. Payman Hajiazim (2 hours later)
Hi there, thanks for asking. If there is tremor at rest and the doctor suspects about Parkinson's disease (which tremor at rest is its hall mark), medications from the class of ergo or the newer medications which are "non-ergo dopamine stimulant" would be beneficial in the early stages.
If the doctor suspects about essential tremor (its hallmark is if the patient's tremor gets better with drinking alcohol), then a better medication (apart from Beta blocker that you mentioned) would be any thing from the class of benzodiazepines (and since he is more than 65, a medication which is not metabolized by the liver like oxazepam or lorazepam) would be the choice.
It is better to ask doctor to take full history, and physical exam to see what is the real cause. Let me know if you have any question. I wish him a good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Payman Hajiazim (4 days later)
Thank you Dr. Hajiazim. If the Dr. has so far ruled out Parkinson's, is there any other organic reason why the tremor could be happening and would lorazepam, or oxazepam be something that would reduce the tremor? He has no other medical history of stroke or heart/coronary disease problems. I am perplexed, and as older people generally are, he is a stubborn guy. Hard to get him to actually move forward with more progressive treatment options. Lastly, should I call his doctor and just ask some questions or is that a patient/doctor confidentiality problem? Thanks so much.
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Answered by Dr. Payman Hajiazim (6 hours later)
Hi there, thanks for asking. any injury to cerebellum can cause intention tremor which does not last in TIA, even if it happens.
Lorazepam or oxazepam will decrease the essential tremor. Family history is usually positive in this case.
By the way it is not ethical to access to his file and the doctor will not do other than he gives verbal consent to.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Payman Hajiazim

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Had transient ischemic attack. On beta blocker. Not getting cure. CT scan, MRI normal. Prognosis?

Hi there, thanks for asking. If there is tremor at rest and the doctor suspects about Parkinson's disease (which tremor at rest is its hall mark), medications from the class of ergo or the newer medications which are "non-ergo dopamine stimulant" would be beneficial in the early stages.
If the doctor suspects about essential tremor (its hallmark is if the patient's tremor gets better with drinking alcohol), then a better medication (apart from Beta blocker that you mentioned) would be any thing from the class of benzodiazepines (and since he is more than 65, a medication which is not metabolized by the liver like oxazepam or lorazepam) would be the choice.
It is better to ask doctor to take full history, and physical exam to see what is the real cause. Let me know if you have any question. I wish him a good health.