Letter to the Editor
Topical Beta Blockers and Essential Tremors: a case
Jalili1, S Sen2, McVicar S3
Ophthalmologist, Warrington Hospital Trust
2 SHO in Ophthalmology,
Warrington Hospital Trust
3 General Practitioner,
Beaumaris, Anglesey, North Wales
An 83-year old lady was
referred to us by her optician. On examination, she was diagnosed to have
bilateral open angle glaucoma. She as otherwise generally lit except tor
the fact that she suffered from senile essential tremors. This was so
severe that it interfered with uh her daily activities so much so she had
to use a straw to drink from a cup or tumbler. She was stated on
Levobunolol 0.5% for her glaucoma.
On review two months
later her glaucoma was well controlled. However, one remarkabke side
effect of the topical Levobunolol was that her essential tremors had
resolved almost completely. She could now hold a cup of coffee and sign
her name as well as pursue other daily act activities quite comfortably.
While systemic beta
blockers (Propranolol 40 mg two to three times a day) have been
recommended for the treatment of severe essential tremors this is the
first instance to the best of’ our knowledge where a topical beta blockers
(two drops of 0.5% Levobunolol twice daily) has succeeded in ameliorating
the symptoms of this distressing condition. This case suggests that
perhaps much lower doses than those currently recommended of systemic beta
blockers could be equally effective in this condition. This would serve to
reduce many of the side-effects such as headaches, gastro-intestinal and
sleep disturbances of this group of drugs.
Rjchardson EP, Adams RD.
Degenerative diseases of’ the Nervous system. In: Harrison’s Principles of
Internal Medicine. 10th ed. McGraw Hill, 1983, pp 2129.