An unusual Association Between Parkinson's Disease (PD) and Essential Tremor (ET) Characterized by opposite Lateral Predominance.

The occurrence of disabling postural and action tremor, which is repotted in less than 15 % of cases of PD. may be due to a combination of ET and PD, We report the case of a patient suffering bilaterally from postural tremor of different etiology on either side. A 69 year-old, right-handed woman with a family history of ET, was referred for bilateral hand tremor which was disabling on the right side. At the age of 61 she noticed a right hand postural tremor. not responsive to $- blockers, followed. two years later, by the onset of postural and action tremor on the opposite side. In the following two years. the patient developed asymmetric right-sided parkinsonism, while the postural and action tremor on the left remained unchanged. At time of evaluation, the patient had asymmetric parkinsonism with a 5 Hz rest and postural tremor on the right side and a postural-action tremor of the left hand. Dopaminergic acute challenge tests were performed. The administration of levodopalcarbidopa (ZOO/SO mg) improved the tremor on the right but not on the left. A progressive and more significant improvement was observed after the administration of increasing doses of apomorphine ( 1.6-3-4.5-6 mg). At the dose of 6 mg, apomorphine nearly completely abolished tremor on the right. The tremor of the left hand remained unchanged. The distinction between the two types of tremor was confirmed by the chronic treatment (using levodopa and dopaminergic agonists). Which improved only the right-sided tremor. Primidone was later introduced and improved selectively the tremor on the left. Conclusions: This patient developed both PD and ET with an unusual opposite prevalence. Drug challenge permitted the differentiation the clinically similar tremor types, which have a different pathophysiology.

Neurologie [Neurology].

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