Intervention Review

Beta-blocker therapy for tremor in Parkinson's disease

  1. Niall J Crosby2,
  2. Katherine Deane3,
  3. Carl E Clarke1,*

Editorial Group: Cochrane Movement Disorders Group

Published Online: 20 JAN 2003

Assessed as up-to-date: 10 SEP 2002

DOI: 10.1002/14651858.CD003361


How to Cite

Crosby NJ, Deane K, Clarke CE. Beta-blocker therapy for tremor in Parkinson's disease. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003361. DOI: 10.1002/14651858.CD003361.

Author Information

  1. 1

    City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Department of Neurology, Birmingham, West Midlands, UK

  2. 2

    University of Birmingham, Department of Neurology, Birmingham, West MIdlands, UK

  3. 3

    Newcastle University, Institute of Health & Society, Newcastle-upon-Tyne, UK

*Carl E Clarke, Department of Neurology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, West Midlands, B18 7QH, UK. c.e.clarke@bham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The tremor of Parkinson's disease can cause considerable disability for the individual concerned. Traditional antiparkinsonian therapies such as levodopa have only a minor effect on tremor. Beta-blockers are used to attenuate other forms of tremor such as Essential Tremor or the tremor associated with anxiety. It is thought that beta-blockers may be of use in controlling the tremor of Parkinson's disease.

Objectives

To compare the efficacy and safety of adjuvant beta-blocker therapy against placebo for the treatment of tremor in patients with Parkinson's disease.

Search methods

Electronic searches of MEDLINE, EMBASE, SCISEARCH, BIOSIS, GEROLIT, OLDMEDLINE, LILACS, MedCarib, PASCAL, JICST-EPLUS, RUSSMED, DISSERTATION ABSTRACTS, SIGLE, ISI-ISTP, Aslib Index to Theses, The Cochrane Controlled Trials Register, Clinicaltrials.gov, metaRegister of Controlled Trials, NIDRR, NRR and CENTRAL were conducted. Grey literature was hand searched and the reference lists of identified studies and reviews examined. The manufacturers of beta-blockers were contacted.

Selection criteria

Randomised controlled trials of adjuvant beta-blocker therapy versus placebo in patients with a clinical diagnosis of idiopathic Parkinson's disease.

Data collection and analysis

Data was abstracted independently by two of the authors onto standardised forms and disagreements were resolved by discussion.

Main results

Four randomised controlled trials were found comparing beta-blocker therapy with placebo in patients with idiopathic Parkinson's disease. These were double-blind cross-over studies involving a total of 72 patients. Three studies did not present data from the first arm, instead presenting results as combined data from both treatment arms and both placebo arms. The risk of a carry-over effect into the second arm meant that these results were not analysed. The fourth study presented data from each arm. This was in the form of a mean total score for tremor for each group. Details of the baseline scores, the numbers of patients in each group and standard deviations were not provided, meaning that the magnitude and significance of any changes due to therapy could not be calculated. One study reported a substantial fall in heart rate in 14 of the 22 patients, with one patient withdrawing after his heart rate dropped to 56 beats per minute (baseline heart rate was not reported).

Authors' conclusions

In view of this lack of evidence, it is impossible to determine whether beta-blocker therapy is effective and safe for the treatment of tremor in Parkinson's disease. The high frequency of bradycardia in one trial raises some concerns about the prescription of beta-blockers to normotensive elderly patients but the study was too small for the true degree of risk to be calculated.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Beta-blockers may be able to help relive tremor for people with Parkinson's disease, but more research is needed on safety and effectiveness.

Tremor is one of the main symptoms of Parkinson's disease, and it can be embarrassing and limit daily activities. The drugs most commonly used for Parkinson's disease tend to be more effective in treating other symptoms of the disease (such as rigidity or slowness of movement). Beta-blocker drugs are used to relieve tremor from other conditions. However, the review found there is not enough evidence from trials to show whether beta-blockers are safe and effective for tremor in Parkinson's disease. The blood pressure lowering effect of beta-blockers may be a problem to people with Parkinson's disease and normal blood pressure.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Beta受體阻斷劑治療帕金森氏症的震顫

帕金森氏症的震顫可能會對個體造成相當大的殘障影響。像是levodopa的傳統抗帕金森治療對於震顫的效果很小。Beta受體阻斷劑被用來緩解其他形式的震顫,像是自發性震顫或焦慮相關震顫。一般認為Beta受體阻斷劑對於帕金森氏症的震顫也有幫助。

目標

比較輔助性Beta受體阻斷劑治療和安慰劑,對於帕金森氏症病患震顫的療效。

搜尋策略

我們搜尋了MEDLINE、EMBASE、SCISEARCH、BIOSIS、MedCarib、PASCAL、JICSTEPLUS、RUSSMED、DISSERTATION ABSTRACTS、SIGLE、ISIISTP、Aslib Index to Theses、The Cochrane Controlled Trials Register、Clinicaltrials.gov、Controlled Trials的metaRegister、NIDRR、NRR和CENTRAL等電子資料庫。手動搜尋Grey literature及檢視找到研究中的參看資料。並和beta收體阻斷劑的製造商連絡。

選擇標準

以臨床診斷患有原發性帕金森氏症的病患做為樣本,比較輔助性beta受體阻斷劑和安慰劑的隨機對照試驗。

資料收集與分析

由2位作者分別將數據摘錄成標準形式,並經由討論解決意見分歧的部分。

主要結論

我們找到4個,以帕金森氏病患為樣本,比較beta受體阻斷劑和安慰劑的隨機對照試驗。它們都是雙盲、交叉的研究,總共包含72位病患。有3個研究沒有列出第一組的數據,只有列出兩種療法和兩個安慰劑的合併數據。第二組有的殘餘效應的風險表示這些結果沒有經過分析。第四個研究有列出各個組別的數據。以每組震顫的平均總分表示。沒有提供每組病人的數目和標準偏差等基礎分數,表示治療的重要性和顯著程度無法被估算。有1個研究回報在22位病患中,有14位有心跳速率明顯下降的現象,其中有1位在心率下降至每分鐘56下後退出試驗﹝沒有列出基礎心率﹞。

作者結論

由於證據的缺乏,我們無法確定以beta受體阻斷劑治療帕金森氏症震顫的有效性及安全性。其中一個試驗,心跳過慢的發生率很高,這挑起了對於開立beta受體阻斷劑給血壓正常的老年病患的關切,但這個研究的規模很小,不足以估算出其真實的風險程度。

翻譯人

本摘要由朱奕蓁翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Beta受體阻斷劑可能可以幫助緩解帕金森氏病患的震顫症狀,但我們需要更多關於其安全性和療效的研究。震顫是帕金森氏症的主要症狀之一,而且可能使人尷尬且限制日常活動。帕金森氏症常用的藥物,對於其它的症狀似乎比較有效﹝像是僵硬或動作緩慢﹞。Beta受體阻斷劑常通常用於治療其他情況造成的震顫。然而,這篇評輪發現目前沒有足夠試驗證據,能證明是否beta受體阻斷劑對於帕金森氏症的震顫確實是安全且有效的。beta受體阻斷劑的降血壓作用,可能會成為患有帕金森氏症,但血壓正常的病患的困擾。