Dr Sudhir Kumar MD DM Profile picture
May 23 10 tweets 3 min read Twitter logo Read on Twitter
Shaking of hands: Essential tremor (ET) or Parkinson's disease (PD)

1. Shaking of hands (tremors) are common. The usual question among patients (and doctors) is what is the root cause- ET or PD?
Here I would highlight the clinical differences between the two.
#MedTwitter
2. ET affects both hands, whereas PD affects one hand (asymmetric ET- one hand more affected than other & unilateral ET- affecting only one hand can rarely occur).
If tremors remain confined to one hand for >3 years, one should look for structural brain disease (unusual for PD).
3. Tremor in ET is brought on by doing an activity (holding a cup of coffee or writing), whereas people with PD have resting tremors.
Tremors in ET can be better seen with outstretched arms and hands.
Tremors in PD can be better seen by distracting the patient (and observing).
4. ET tremors are suppressed by alcohol intake (I wouldn't recommend this for those who don't drink).
ET tremors are made worse with anxiety or when in presence of strangers or when someone is watching the patient.
5. Over a period of time, the severity of tremors in ET remains same or there is only mild worsening. However, tremors in PD get worse over time.
Additional symptoms such as slowness of movements, postural imbalance, or stiffness of arms, when present, are suggestive of PD.
6. In ET, tremors can involve head & neck, voice and jaw. Leg tremors are rare in ET.
Resting tremors in legs favor a diagnosis of PD.
#neurotwitter #Parkinsons #tremor
7. ET is more of a social problem (embarrassment for the patient), and sometime causes fear whether it is PD or not.
ET is rarely disabling.
On the other hand, PD causes motor disability in most people, especially after 5 years of symptom onset.
8. Tremors of ET as well as PD disappear during sleep.
Positive family history is present in 50% of ET patients, as compared to only 15% in PD patients.
9. Drugs helpful in treating ET tremor: propranolol and primidone.
Drugs helpful in treating PD tremor: Levodopa, dopamine agonists, anticholinergics.
Deep brain stimulation (DBS) works in both.
10. Finally: 6-19% of patients with ET can progress to develop PD after a mean duration of 22 years. Fortunately, ET history in patients with PD is associated with a benign prognosis with slower motor and non-motor progression.
nature.com/articles/s4159…

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More from @hyderabaddoctor

May 22
1. One of my patients with epilepsy, who was well-controlled on medicines for 2 years, presented with 2 episodes of seizures.
She was lost to follow-up for past 14 months.
On enquiry, she told that she had stopped medicines prescribed by me, and had started taking Ayurvedic Rx.
2. Me: What was the name of Ayurvedic medicine you took?
Patient: It was powder mixed with honey wrapped in a paper (no packaging). No name was mentioned by the "famous" Ayurvedic doctor of her town.
#MedTwitter
3. Me: Why did you stop taking the medicine?
Patient: I was concerned that medicine would cause adverse effects.
Me: And you felt safe in taking Ayurvedic medicine without knowing even its name or what it contains?
Patient: I now realize it was a mistake.
Read 4 tweets
May 21
Weight gain before 30 increases the risk of fatal prostate #Cancer

1. Prostate cancer is the second commonest cancer among men (after lung cancer). Advancing age, positive family history & several genetic markers are non-modifiable risk factors of prostate cancer.
#MedTwitter
2. A recent study looked at the association between weight gain and risk of developing prostate cancer among 258,477 men aged 17 to 60.
#weightgain #prostatecancer
3. Overall, men who gained a little over 1 pound per year (1.10 pounds) had, compared with those with stable weight, a 10% increased risk of getting aggressive prostate cancer later in life, and a 29% increased risk of dying from it.
Read 5 tweets
May 9
When medicines fail, do prayers & positive frame of mind help?
1. Mr Raja to me- “Dr, I won’t die in 6 months. Prescribe the best medicines; I am sure I’ll defeat my disease.” His mother too echoed his words- “Dr, I love my son, and will always stand by his side, come what may.”
2. Mr Raja had consulted me with headache of 10 days duration. While going to a spa for head massage, he thought of getting an opinion of a neurologist. As it was a new-onset headache, I ordered for a CT scan, which showed a mass lesion.
#MedTwitter #neurotwitter
3. Further investigations, including MRI brain, followed by brain biopsy confirmed it to be a high grade glioblastoma multiforme (GBM), an aggressive brain cancer with average survival of 12-18 months.
Read 13 tweets
May 8
Longer daytime napping is associated with new-onset heart failure in older people

1. Disrupted nighttime sleep is associated with heart failure (HF).
A prospective study looked at the association between daytime napping and incident HF during follow up.
#napping #HeartFailure
2. Participants who napped longer than 44.4 minutes (ie, the median daily napping duration) showed a 73% higher risk of developing incident heart failure than participants who napped <44.4 minutes.
3. Participants who napped >1.7 times/day showed a 120% increase in new onset HF compared with participants who napped <1.7 times/day.
These associations persisted after adjustment for covariates, including nighttime sleep, comorbidities, and cardiovascular disease/risk factors.
Read 5 tweets
May 6
Daytime napping for >30 minutes increases the risk of atrial fibrillation
1. Some nap during daytime as a habit, whereas a few try to catch up on lost sleep at nights with some daytime napping.
However, there is some bad news for those napping >30 minutes during daytime.
#sleep
2. In a recent study, compared to short daytime nappers(<30 min), those who snoozed for 30 minutes or more per day had a nearly doubled risk of developing atrial fibrillation (AF).
Meanwhile, compared with short nappers; risk was not elevated in those who avoided #napping.
3. Further analysis was done based on the nap duration.
Compared with those who napped for more than 30 minutes per day, those who napped for less than 15 min had a 42% lower risk of developing atrial fibrillation; while those who napped for 15 to 30 min had a 56% reduced risk.
Read 7 tweets
May 5
1. Today at work: Conversed with patients in Tamil, Telugu, Bangla, Hindi, English, Somali & Arabic during ward/ICU rounds & OPD.
Brought smiles on patient's faces as well. I love interacting with people/patients in their own languages as they love listening to own languages. twitter.com/i/web/status/1…
2. I have seen agitations against various languages in many states, which are futile. It is always good to learn more languages, as it is a win-win situation.
(below pictures are from the internet) ImageImage
3. Speaking two languages, moreover, delays the age of onset of dementia by an average of 4.5 years. This benefit is seen in educated as well as illiterate people. doi.org/10.1212/01.wnl…
Read 4 tweets

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