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Dr. Andrew Rynne

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What causes tremors in an elderly person?

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Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 910 Questions

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Posted on Mon, 9 Nov 2015 in Hypertension and Heart Disease
Question: Hello Doctors,
My dad is almost 70 years old. He was suffering from Trembling Hands & Hypertension for last 1 year. He is otherwise all active, does regular exercise, follows regular healthy home diet with no major medications or diseases. He used to be a regular smoker but has quit smoking completely for last 3 years. He does not have any other addictions and has always remained non-alcoholic. He frequently feels urge to pass urine but he gets time to find a place / bathroom and has never had wet pants (persistent for last 5 years). He speaks, shouts and sometimes throws fist / arms / legs during sleep (more than 5 years). However he has never done sleep walking.
We were worried about the Trembling Hands and when we consulted Neurologist, he suggested MRI. The MRI came with diagnosis of "Lacunar Pontine Infarct" and "Polyp in left maxillary sinus". I have attached all Reports including MRI, Echo Cardiogram and other Blood Test Reports.
I need your suggestion in understanding the risk of these diagnosis and what should be suggested medication or things to be done to avoid any future casualties. Are current medications correct or need any change?
Thanks in advance for your kind guidance.
Regards,
xxxxx
doctor
Answered by Dr. Priyank Mody 3 hours later
Brief Answer:
All reports withen normal range, USG for prostate. Medication modification

Detailed Answer:
Hello I am Dr. Mody and I would be addressing your concern.
Thank you for the detailed history.
As I start let me assure you that the MRI is very much withen normal and will have no major problem in his life.
1) lacunar infarct see very tiny infarts less than 2 mm, if we do our MRI when we are 70 years of age we too may have such small infarts, however as it shows some atherosclerosis, it's wide to start on blood thinner and cholesterol medication so as to prevent future infarts.
Deplatt and roasvel is for the same.
2) poly is not in brain but the sinus, it's completely incidental finding and no treatment needed for it.

Cardiac report s are pretty normal, even the blood pressure mentioned on prescription is normal and so active treatment needed for that

By the symptoms you describe and his age things fit into the diagnosis of Parksinsons disease.
Your doctor has started on basic dosage of syndopa and procydin 2.5 mg for the same.
That should help subside the symptoms in major way, however regular follow up is needed so he can titrate the medication according to symptoms.
Now tremors, night issue, and increased urinary frequency is all explained by Parksinsons disease.

However I would like to add that it's wiser to get sonography of prostate, considering his age as that might be the cause of urinary symptoms and starting medication for the same will help.

Some important notes
1) deplatt cv contains atorvastatin and Rosavel are same drugs, not both are needed. May stop rosavel after discussing with your doctor
3) moza plus has mosapride which will cause dey mouth, the same is important side effect procydin. So may consider alternative to moza plus. Like pantoprazole with , as it doesn't cross to the brain.


Family support will be important along with medication here as Parksinsons is a progressive and chronic disease, however with medication we can delay symptoms to help him live a normal life.

Let me know if any clarification needed.
Regards Dr Priyank Mody

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Priyank Mody 2 days later
Hello Dr. Mody,

Thanks for your detailed response and medicinal change suggestions. Sorry I was unable tobrespond earlier since I was travelling.

I am much relieved now. We will change Moza Plus as you suggested. Also will do the USG.

Thanks Again,
xxxxxx
doctor
Answered by Dr. Priyank Mody 15 hours later
Brief Answer:
Wishing your father the best of health

Detailed Answer:
Happy I could help,
The USG prostate is just to rule out any reversible cause.
Parksinsons is a chronic progressive decease, so it will take some time till your doctors can titrate and fix the best dose suitable for your father, so be patient with both the doctor and the patient and things should be good in 4-6 weeks times.
Not to worry much, as nothing seems so serious.
Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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