A Double-Blind Trial of Clonazepam in Benign Essential Tremor

Thompson, Chloe; Lang, Anthony E.; Parkes, Jeannette; Marsden, C. D.

doi:10.1097/00002826-198403000-00004

Cited by 64 publications

(23 citation statements)

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“…Overall, primidone is considered likely efficacious with a benefit of around 60 % reduction in tremor amplitude [25], which correlates with accelerometry findings (59 %; range, 42-76 %) [25,38,[44][45][46]. At least 50 % of patients experienced some benefit, and occasional "dramatic responders" have been [27] Acetazolamide/methazolamide Olanzapine Clozapine (18-75 mg) [28] Amantadine Pregabalin Flunarizine (10 mg) [29] Carisbamate Tiagabine Nadolol (120-240 mg) [30] Isoniazid Sodium oxybate Nimodipine (120 mg) [31] Levetiracetam Zonisamide Botulinum toxin (depending on injected muscles) Patients in the surgical studies usually have much higher tremor amplitudes. Tremor amplitude estimation is based on standard algorithms computed as change in tremor rating scale and change in tremor amplitude on accelerometry [9,15] described.…”

Section: Primidonementioning

confidence: 66%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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Tremor is a hyperkinetic movement disorder characterized by rhythmic oscillations of one or more body parts. It can be disabling and may impair quality of life. Various etiological subtypes of tremor are recognized, with essential tremor (ET) and Parkinsonian tremor being the most common. Here we review the current literature on tremor treatment regarding ET and head and voice tremor, as well as dystonic tremor, orthostatic tremor, tremor due to multiple sclerosis (MS) or lesions in the brainstem or thalamus, neuropathic tremor, and functional (psychogenic) tremor, and summarize main findings. Most studies are available for ET and only few studies specifically focused on other tremor forms. Controlled trials outside ET are rare and hence most of the recommendations are based on a low level of evidence. For ET, propranolol and primidone are considered drugs of first choice with a mean effect size of approximately 50 % tremor reduction. The efficacy of topiramate is also supported by a large double-blind placebocontrolled trial, while other drugs have less supporting evidence. With a mean effect size of about 90 % deep brain stimulation in the nucleus ventralis intermedius or the subthalamic nucleus may be the most potent treatment; however, there are no controlled trials and it is reserved for severely affected patients. Dystonic limb tremor may respond to anticholinergics. Botulinum toxin improves head and voice tremor. Gabapentin and clonazepam are often recommended for orthostatic tremor. MS tremor responds only poorly to drug treatment. For patients with severe MS tremor, thalamic deep brain stimulation has been recommended. Patients with functional tremor may benefit from antidepressants and are best be treated in a multidisciplinary setting. Several tremor syndromes can already be treated with success. But new drugs specifically designed for tremor treatment are needed. ET is most likely covering different entities and their delineation may also improve treatment. Modern study designs and long-term studies are needed.

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Section: Primidonementioning

confidence: 66%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…32 Clonazepam had little efficacy in a class III study of 15 patients taking 0.5 to 4 mg/day, and there was a 40% completion rate due to drowsiness. 33 The use of clonazepam is recommended with caution due to its abuse potential and possible withdrawal symptoms following abrupt discontinuance. 34 Clozapine (Clozaril).…”

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confidence: 99%

Practice Parameter: Therapies for essential tremor [RETIRED]

et al. 2005

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Abstract-Background: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. Results and Conclusions: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.

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“…This tremor is believed to result from an enhanced form of central oscillations that are also seen in healthy people and hence is called enhanced physiologic tremor. The tremor frequency band of [8][9][10][11][12] Hz is similar to that of the physiologic tremor. Easy visibility of the tremor, postural nature and no evidence of underlying neurologic disease are the defining features of this entity.…”

Section: Diagnosismentioning

confidence: 58%