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July 1986

Attenuation of Response to Mental Stress in Patients With Essential Tremor Treated With Metoprolol

Author Affiliations

From the Dent Neurologic Institute (Dr Gengo) and Department of Neurology (Drs Kalonaros and McHugh), Millard Fillmore Hospital, Buffalo; and the School of Pharmacy and Medicine, State University of New York at Buffalo (Drs Gengo and McHugh).

Arch Neurol. 1986;43(7):687-689. doi:10.1001/archneur.1986.00520070045016

• The response to mental stress in patients with benign essential tremor is an exaggeration of the resting tremor. We have studied the ability of metoprolol tartrate to attenuate specifically the tremorgenic response to mental stress in five patients with essential tremor who were each studied on four occasions. Treatment regimens consisted of 0-, 25-, 50-, and 75-mg doses of metoprolol tartrate, given twice daily for seven- to ten-day periods. Tremor was measured while patients were resting comfortably and then again following mental stress over eight-hour study periods. During the baseline study period, the investigational mental stress consistently exaggerated tremor in each patient. Metoprolol treatment reduced both the resting tremor and tremor following mental activity, but the druginduced change in the response to mental stress was more pronounced than the drug-induced reduction in resting tremor. The ability of metoprolol to blunt the response to mental stress was associated with serum concentrations of the drug. The time courses of metoprolol serum concentrations were similar to the time course of metoprolol's ability to blunt the response to mental stress. Metoprolol possesses the ability to blunt the tremorgenic response to mental stress in patients with essential tremor, but the duration of this effect lasts less than seven hours after administration of a dose.

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