Relative efficacy of alcohol and propranolol in action tremor

Thirty-nine patients with a variety of diseases, including essential tremor, Parkinson's Disease, olivopontocerebellar degeneration, ataxia telangiectasia, and cervical cord injury with action tremor, were evaluated for the effect of one ounce of absolute alcohol ingestion. Tremor significantly subsided in 61.9% of E.T.; 46.6% of P.D.; one patient with A.T.; and one patient with C6 lesion. The tremor became worse in one patient with O.P.C.D. Twenty of these patients were treated with propranolol, an average dose of 92 mgm. per day, and re-evaluated three to six months later. All those who improved on alcohol improved on propranolol and the one whose tremor accentuated with alcohol had a similar response to propranolol. It is concluded that the tremorilytic effect of alcohol is neither specific for, nor limited to, essential tremor and is of no value in differentiating various neurological disorders which manifest as action tremor. It is recommended that one ounce of absolute alcohol by mouth be used as an office procedure to predict the response of patients' tremor to propranolol.

Polyneuropathy

Polyneuropathy is characterized by simultaneous bilateral symmetrical involvement of peripheral nerves. Clinical features in fully-developed cases are paresthesias, irregular 'glove and stocking' cutaneous sensory loss, loss of deep sensations, weakness of distal muscles of extremities, and absent deep tendon reflexes. The most common forms of neuropathy encountered in practice are -- alcohol-induced, Guillain-Barre syndrome, and that secondary to diabetes mellitus. Since PN has many causes, a scheme based on clinical features is presented so that the possibilities can be narrowed and pursued with further investigations.