Journal of Neurology

, Volume 265, Issue 11, pp 2695–2703 | Cite as

Differential effects of propranolol on head and upper limb tremor in patients with essential tremor and dystonia

  • Giulia Paparella
  • Gina Ferrazzano
  • Antonio Cannavacciuolo
  • Francesco Cogliati Dezza
  • Giovanni Fabbrini
  • Matteo Bologna
  • Alfredo BerardelliEmail author
Original Communication


Propranolol is used as the first-line treatment in essential tremor and it has also been proposed as a treatment for tremor in dystonia. However, several issues remain uncertain. For example, it is still not clear whether propranolol exerts a beneficial effect on head tremor. Moreover, no studies have investigated whether the effect of propranolol on head and upper limb tremor in essential tremor differs from that in dystonia. We aimed to assess the effects of propranolol on tremor in different body parts in essential tremor and in patients with tremor and dystonia. Twenty-nine patients with head and upper limb tremor were enrolled in the study, 14 with essential tremor, and 15 with dystonia. Participants underwent a clinical and kinematic analysis of tremor in two sessions, i.e., without (baseline) and ‘on therapy’ with propranolol. We found that head tremor was more severe in patients with dystonia, while upper limb tremor was more evident in patients with essential tremor (P < 0.05). Propranolol had no effect on head tremor in either group (all Ps > 0.05), but it did reduce upper limb tremor in patients with essential tremor. The present study demonstrates differential effects of propranolol on head and upper limb tremor in patients with essential tremor. The lack of effect on head and upper limb tremor in patients with dystonia suggests that the pathophysiological mechanisms underlying tremor in these two conditions and in different body parts may be distinct.


Essential tremor Dystonic tremor Head tremor Upper limb tremor Propranolol 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

None of the authors have any potential conflicts of interest to disclose.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Giulia Paparella
    • 1
  • Gina Ferrazzano
    • 2
  • Antonio Cannavacciuolo
    • 1
  • Francesco Cogliati Dezza
    • 1
  • Giovanni Fabbrini
    • 1
    • 2
  • Matteo Bologna
    • 1
    • 2
  • Alfredo Berardelli
    • 1
    • 2
    Email author
  1. 1.Department of Human NeurosciencesSapienza University of RomeRomeItaly
  2. 2.IRCCS NeuromedPozzilliItaly

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