beta-Adrenoreceptor antagonists in essential tremor.

Jefferson, D; Jenner, P; Marsden, C. D.

doi:10.1136/jnnp.42.10.904

Cited by 94 publications

(35 citation statements)

References 21 publications

(21 reference statements)

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“…However, side effects are common and frequently doselimiting (see below). The average study cohort size was 18 adults (range, [11][12][13][14][15][16][17][18][19][20][21][22], and thus similar to beta blocker studies, but many randomized patients in studies did not complete the trials. Besides drowsiness and dizziness reported by most patients on total daily dosages of 500 mg or more, children, elderly, and patients with comorbid psychiatric disorders are prone to develop depression, cognitive, and behavioral effects.…”

Section: Primidonementioning

confidence: 99%

“…The different betablockers have also helped the understanding of the pharmacology of betablockers. It is likely that betablockers work mainly through central and peripheral beta-blockade and β2-receptors mainly [21][22][23]43].…”

Section: Propranolol and Other Betablockersmentioning

confidence: 99%

“…For propranolol, we identified 13 relevant double-blind, placebo-controlled trials using a crossover design [22,23,[34][35][36][37][38][39][40][41] and 2 studies with a parallel design [34,42]. Notably, mean duration of treatment (60-240 mg per day) on stable dosages of medication was less than 3 weeks.…”

Section: Propranolol and Other Betablockersmentioning

confidence: 99%

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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: 99%

Section: Propranolol and Other Betablockersmentioning

confidence: 99%

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The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…In the same way, reductions of standing and supine pulse rates were used by Jefferson et al (1979) and equal reductions of sitting pulse rate (Dietrichson & Espen, 1981), or inhibition of standing tachycardia (Calzetti et al, 1982;Abila et al, 1983) were used to establish equivalence of cardiac 1-adrenoceptor blockade. Perucca et al (1981) noted that the decrease in tremor due to propranolol was proportionately greater than the bradycardia seen during exercise, suggesting that 132-adrenoceptors in the periphery had a greater affinity for propranolol than the 1-adrenoceptors in the heart.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism by which ,-adrenoceptor antagonists reduce essential tremor has been discussed in terms of the relative importance of antagonism at fl-and P2-adrenoceptors and of the relative ability of the drugs to enter the brain (Jefferson et al, 1979;Calzetti et al, 1982;Collier & Leigh, 1983;Abila et al, 1983). Less (Birmingham et al, 1977).…”

Section: Introductionmentioning

confidence: 99%

Effect on finger tremor of withdrawal of long‐term treatment with propranolol or atenolol.

Wharrad¹,

Birmingham²,

Cf³

et al. 1984

Brit J Clinical Pharma

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The effect of the withdrawal of long‐term beta‐adrenoceptor blockade on pulse rate and finger tremor was studied in 27 patients who had been treated for 2 years following an uncomplicated myocardial infarction with either atenolol, propranolol or placebo. During treatment, pulse rate was significantly lower in patients treated with propranolol or atenolol compared with placebo. Compared with the response in the placebo group the mean increase in tremor on withdrawal of propranolol was statistically significant for postural and for work tremor in both hands. A significant increase in tremor on withdrawal of atenolol occurred only in the postural position and in a narrow frequency band (left hand, 7‐11 Hz; right hand, 7‐9 Hz). The differences in the effect on tremor of withdrawal of treatment with propranolol or atenolol in doses which produced similar reductions in heart rate, emphasise the beta 2 classification of peripheral receptors associated with normal muscle tremor but do not exclude the involvement of beta 1‐ adrenoceptors.

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Acute and chronic effects of clozapine in essential tremor

et al. 1999

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Patients with essential tremor (ET) may not respond to commonly used drugs. Clozapine, an atypical neuroleptic drug, has been reported to improve postural Parkinson's disease tremor clinically resembling ET. The effects of a single dose of 12.5 mg clozapine and placebo were evaluated in a randomized, double‐blind, crossover study in 15 drug‐resistant patients with ET. Patient responders with more than 50% improvement after a single dose of clozapine subsequently received the drug (39 ± 9 mg up to 50 mg) unblinded for a period of 15.8 ± 7.7 months. Tremor was effectively reduced by a single dose of clozapine in 13 of 15 patients (p <0.01). Sedation was the only side effect reported during the clozapine test; however, the time course of sedation and of the antitremor effect were not coincident. A significant reduction of tremor was reported with chronic clozapine treatment (p <0.01) with no tolerance to drug antitremor effect, whereas sedation markedly decreased after 6–7 weeks of therapy. No clozapine‐induced hematologic side effects were observed in our cohort of patients during long‐term treatment. Our results suggest that in selected drug‐resistant ET cases, clozapine should be considered before resorting to neurosurgical options.

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beta-Adrenoreceptor antagonists in essential tremor.

Cited by 94 publications

References 21 publications

The Treatment of Tremor

The Treatment of Tremor

Effect on finger tremor of withdrawal of long‐term treatment with propranolol or atenolol.

Acute and chronic effects of clozapine in essential tremor

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