Q: I am 45 years old. My father was a Parkinson's disease patient and had remained on medication for a long time. He developed this disease at the age of 50. He expired at the age of 67 years. I am a patient of high blood pressure (BP) and taking drugs for the same. I am experiencing problem of hand shaking while holding cup, glass, plate, bottle or any other object for about two years. There is no shaking in any other body part. I consulted a neurologist who diagnosed the disease as essential tremors and not Parkinson's. He prescribed Inderal 10 mg tablet in place of Atenolol tablet 100 mg. He advised me to consult my cardiologist before starting the medicine. The cardiologist felt that the dosage of Inderal was too little so he increased the same and finally prescribed the following: Ideral 40 mg (twice daily- morning and evening) in place of Atenolol 100 mg and kept other medicines same viz, Repace-H 1OD (morning), Lotensyl 10 mg 1OD (morning), Evion 400 mg 1OD(morning), Atorva 10mg 1OD(evening)- For Cholesterol which was slightly on the higher side. I am taking these medicines for the past 8 months but there is not much improvement in shaking. Am I leading towards Parkinson's disease.

A:Parkinson's disease most commonly presents at its onset with a resting tremor in one hand. The diagnosis is usually made by a set of findings that include resting tremor, a history of slowing down and rigidity. It becomes more and more common beyond the age of 50 but rarely can occur at a much earlier age (around the age of 30), which implies a hereditary form. The only symptom you describe does potentially appear consistent with a diagnosis of Essential Tremor; this type of tremor runs much more commonly in families than does Parkinson's Disease. I presume the Neurologist who saw you took the time to get a detailed account of your symptoms before doing a full neurological examination, prior to making the diagnosis. If the diagnosis of Essential Tremor is valid, then you are on one of the first line medications used for it. The fact that your tremor has not improved may relate to the fact that you are not on an optimal dose of medication, or may be because the medication is not the right one for you (there are other medications available for the treatment of Essential Tremor). The dose of 40 mg of propanolol (Inderal) twice a day is still a low one and there is room for you to go up on it. It may well be that a higher dose will provide relief from your symptom. You should see your Neurologist for regular follow-ups as it allows them to keep a record of your symptom and to assess the effectiveness of any medication they have prescribed. As the beta-blocker is also being used to control your blood pressure, it is important for your Neurologist and Cardiologist to co-ordinate your care. I would as a first step go back to the Neurologist and let them re-assess you.