Jim is 70 years old and still working as a university professor. A few years ago, he started to notice uncontrollable hand and arm shaking after taking a new antihypertensive drug called Serpalan®. His physician put him on another regimen to control his hypertension, but he continued to have subtle movement problems. While his hands and arms no longer shook, he did notice an odd twitch in his shoulder, which eventually progressed to a noticeable tremor in his right arm and leg. Jim’s doctor diagnosed this as being due to the stress of his job, and advised that he take a vacation. Luckily, it was the end of spring term and Jim had no commitments for the summer.
Jim took a long, relaxing summer off, but after returning to work both he and his students noticed that his handwriting had become nearly illegible. He also began having problems cutting his food at dinner, and getting his morning cup of coffee to his lips was a trial. However, he insisted that this was due to stress and that “shakiness has always run in my family.”
His doctor insisted on a neurological exam, which yielded the following results:
- Normal gait
- Mild voice tremor and mild bradykinesia
- Mild intention tremor of the arm
- Rigidity of his limbs and trunk (intermittent)
- Normal MRI and EEG
In discussing treatment options, his doctor listed the following: (1) prescription for Parlodel and/or Deprenyl; (2) deep brain stimulation might also be an option if symptoms continued to progress with pharmacological treatment.
Questions
- What condition or conditions (there may be more than one possibility) are being described in this case? Does this involve brain damage, a specific disease or disorder, or some other condition that may be affecting the patient’s ability to move?
- What brain area or area(s) may be involved? How should they function normally? What could be causing this dysfunction?
- How would the treatments recommended affect the brain? How might those effects relate to the symptoms? If deep brain stimulation were pursued, what area of the brain would be stimulated?
- How can you explain all of the symptoms exhibited by this case? Can you relate each symptom to a specific brain area or neurotransmitter?
- What other interventions may be possible, besides those noted here?
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