The clinical features and functional impact of valproate-induced tremor

Alonso-Juárez, Marlene; Torres-Russotto, Diego; Crespo-Morfin, Paulina; Baizabal‐Carvallo, José Fidel

doi:10.1016/j.parkreldis.2017.09.011

Cited by 27 publications

(19 citation statements)

References 11 publications

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“…Among 118 consecutive patients treated with valproate, postural upper limb tremor was the most common type of tremor, observed in 49% of cases (Table S1). In this study, we included 28 patients with valproate‐induced tremor requiring treatment for such tremor, and 29 consecutive patients with ET. Patients were taking valproate at a mean dose of 18.8 mg/kg (range: 8‐33 mg/kg).…”

Section: Resultsmentioning

confidence: 99%

“…We have shown that a proportion of these patients require pharmacological treatment for their tremor. These patients were on average 6 years older than those not requiring therapy for drug‐induced tremor, and women were overrepresented in patients with valproate‐induced tremor …”

Section: Discussionmentioning

confidence: 99%

“…We studied a cohort of 118 consecutive patients taking valproate due to different neurological disorders. From this cohort, we identified 28 (24%) patients with valproate‐induced tremor requiring pharmacological treatment due to the severity of the tremor or functional impairment . The decision to start therapy was taken after asking each patient whether therapy was necessary for their tremor; propranolol up to 40 mg three times a day was provided.…”

Section: Methodsmentioning

confidence: 99%

“…All these patients fulfilled the following criteria: They were older than 14 years old, both genders, and were taking anticonvulsants for at least the previous 3 months and within the last 6 hours from the clinical assessments. No patient with valproate‐induced tremor was taking medications with a known antitremorigenic effect such as topiramate, gabapentin, primidone, beta‐blockers, benzodiazepines, or medications that can induce or exacerbate tremor such as dopamine receptor blockers . We excluded 8 patients with tremor before starting treatment with valproate, or when clinical features supporting an alternate diagnosis such as dystonic or psychogenic tremor were present.…”

Section: Methodsmentioning

confidence: 99%

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Distinguishing features between valproate-induced tremor and essential tremor

Alonso-Juárez

Baizabal‐Carvallo

2018

Acta Neurol Scand

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Distinguishing features between valproate-induced tremor and essential tremor

Alonso-Juárez

Baizabal‐Carvallo

2018

Acta Neurol Scand

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“…Besides ethanol, several antiepileptics are used in the treatment of ET, including topiramate, gabapentin (Deuschl et al 2011) and levetiracetam (Bushara et al 2005). VPA also increases GABAergic mechanisms, however it induces pathological tremor more frequently than other anticonvulsants (Alonso-Juarez et al 2017). Moreover, VPA is associated with drug-induced Parkinsonism (Sasso et al 1994;Brugger et al 2016;Morgan et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Lamotrigine Induces Tremor among Epilepsy Patients Probably via Cerebellar Pathways

Kovács

Farkas

Kelemen

et al. 2019

Tohoku J. Exp. Med.

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Lamotrigine, a frequently used antiepileptic drug, inhibits voltage-gated sodium-channels. By suppressing the release of glutamate and aspartate, lamotrigine acts as a membrane stabilizer, and it is also effective in bipolar disorder and migraine. However, lamotrigine is known to induce tremor among 4-10% of patients. We examined the lamotrigine-induced tremor in 28 epilepsy patients (age: 38.06 ± 13.56 years; 24 females and 4 males) receiving lamotrigine monotherapy and compared the data to 30 age-and sex-matched controls (age: 33.06 ± 10.71 years; 25 females and 5 males). Tremor was visually assessed by clinical tremor rating scales. Quantitative characteristics (intensity, center frequency and frequency dispersion) which are regularly used to differentiate various tremor syndromes were measured by validated, sensitive biaxial accelerometry in resting, postural and intentional positions. Regularity of repetitive finger and hand movements and reaction time were also determined. Data were statistically analyzed. Clinical tremor rating scales detected pathological tremor in three patients (10%), while accelerometry revealed tremor in seven patients (25%). Center frequency of patients with pathological tremor was similar to controls, but the frequency dispersion was significantly lower and tremor intensity was significantly higher in both postural and intentional positions. Rhythmic movements and reaction time were normal. Our results show that objective measurements detect pathological intention tremor in 25% of epilepsy patients receiving lamotrigine monotherapy. Quantitative characteristics suggest the involvement of the cerebellum in the pathomechanism of lamotrigine-induced tremor. Determining the parameters of drug-induced tremor syndromes might help to understand the complex action of tremor generator networks.

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