For many living with Parkinson’s disease, managing tremors can often feel like a frustrating uphill battle.
Levodopa, the go-to medication for treating the condition, doesn’t always hold up—especially in stress-laden moments when tremors can intensify.
That’s where propranolol, a lesser-known ally, comes into play.
Research has begun to uncover how this beta-blocker can help reduce tremors even when stress mounts, indicating a complex relationship between emotional responses and physical symptoms.
Stress and Tremors
Dr. Rick Helmich, a neurologist at Radboud University Medical Center, has noted a common thread among Parkinson’s patients: tremors tend to worsen with rising stress.
While levodopa helps many individuals, its effectiveness often declines in the heat of stress, when tremors frequently reach their peak.
Helmich and his team became curious about whether propranolol, known for its ability to diminish the impacts of stress hormones, could offer a fresh approach in managing these challenging symptoms.
Originally developed to treat high blood pressure and heart rhythm issues, propranolol has been a standard intervention for essential tremor—a condition that occurs without accompanying neurological disorders.
Despite earlier hints that propranolol could also ease tremors in those with Parkinson’s, comprehensive research had been lacking until now.
In their recent study, Helmich and colleagues set out to understand propranolol’s effects on tremors in a group of 27 Parkinson’s patients.
Participants alternated between receiving propranolol and a placebo across various sessions.
To measure tremor severity, a specialized hand device was employed, while MRI scans revealed brain activity during both relaxed states and stressful mathematical tasks.
The team concurrently monitored physiological indicators of stress, such as pupil dilation and heart rate, both of which surged during the tasks.
Consistent with previous observations, tremors became more pronounced in the absence of medication when subjects faced stress.
Impact of Propranolol
The results were illuminating: propranolol not only tamped down tremors during rest but also during stress-inducing activities.
MRI findings indicated reduced activity in the brain circuits linked to tremor control after participants took propranolol.
Helmich elaborated that disarray in dopamine pathways can lead to exacerbated tremors; interestingly, the stress hormone noradrenaline appears to heighten these tremors within essential areas of the brain responsible for movement.
Propranolol seems to mitigate this aggravating effect, leading to notable symptom relief.
The research team found some of their findings especially surprising—especially concerning the drug’s impact on resting tremors.
It turns out that the body’s stress system can remain active even outside of identified stressors, leading to unpredictable fluctuations in tremor severity.
Researcher Anouk van der Heide pointed out this surprising revelation, challenging the past belief that stress hormones only spiked in stressful situations and not during moments of relative calm.
In his own practice, Helmich has begun prescribing propranolol to select Parkinson’s patients.
He stresses, however, that while levodopa is typically the most effective means to address various Parkinson’s symptoms, it falls short for about 40% of individuals with tremors.
For those who don’t respond to increased doses of levodopa, propranolol emerges as a viable secondary option; Helmich does caution that monitoring for side effects like hypotension is essential.
Holistic Approaches
Beyond pharmacological approaches, Helmich’s team is also exploring lifestyle adjustments that might assist in alleviating Parkinson’s symptoms.
They recognize that even minor stressors—like worrying about whether a door is locked—can trigger significant tremors.
Thus, they’re investigating how mindfulness practices could potentially reshape the body’s response to stress, providing a holistic benefit to those living with Parkinson’s disease.
As the research unfolds, it paints a hopeful picture for those grappling with Parkinson’s. Propranolol could offer a fresh avenue for relief, particularly for tremors exacerbated by the pressures of daily life.
Source: ScienceDaily