Primidone Therapy for Essential Vocal Tremor

Nida, Andrew; Alston, Josie; Schweinfurth, John M.

doi:10.1001/jamaoto.2015.2849

Cited by 25 publications

(12 citation statements)

References 20 publications

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“…A retrospective chart review (n=30) reported that approximately 50% (n=14) of patients taking primidone had improvement in vocal tremor. Head tremor does not consistently respond to primidone 127128129…”

Section: Treatment Of Essential Tremormentioning

confidence: 99%

Essential tremor: diagnosis and management

Shanker

2019

BMJ

110

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Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as “essential tremor plus.” Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.

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Section: Treatment Of Essential Tremormentioning

confidence: 99%

Essential tremor: diagnosis and management

Shanker

2019

BMJ

110

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“…Other agents include alternate beta-agonists and anticonvulsants as well as benzodiazepines and carbonic anhydrase inhibitors. It is important to note that although these medications usually do not completely resolve the tremor, they dampen its amplitude successfully in 25–55.6% of patients [ 49 , 50 , 51 ]. By comparison, BoNT has a reported 70% tremor reduction rate in the literature, and patient-reported vocal quality improvement in 56–100% of patients [ 45 , 46 , 47 , 48 , 85 ] (See Table 1 ).…”

Section: Vocal Tremormentioning

confidence: 99%

Chemodenervation of the Larynx

Kaye

Blitzer

2017

Toxins

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Botulinum neurotoxin (BoNT) has existed for thousands of years; however, it was not medically utilized until investigations into its therapeutic use began in sincerity during the late 1970s and 1980s. This, coupled with the reclassification of spasmodic dysphonia as a focal dystonia, led to the use of chemodenervation for this disorder, which has since become a refined technique. Indeed, due to its safety and efficacy, BoNT has been investigated in multiple neurolaryngology disorders, including spasmodic dysphonia, vocal tremor, and muscle tension dysphonia. BoNT has been shown to be a useful and safe adjunct in the treatment for these disorders and may reduce or eliminate oral pharmacotherapy and/or prevent the need for a surgical intervention. We present the historical background, development, proposed mechanisms of action, uses, and techniques for administering BoNT for laryngeal disorders, with a particular focus on spasmodic dysphonia.

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“…Whereas several pharmacologic options with level A or B evidence are available for the treatment of ET that affects the limbs, few such options are available for treating EVT. Efficacy studies for EVT primarily address BTA treatment, or have implemented open‐label designs or retrospective analyses to study pharmacological alternatives such as propranolol or primidone . Prospective studies that include strong experimental controls and objective measures of voice tremor are needed to determine the potential benefit of drug alternatives in EVT.…”

Section: Discussionmentioning

confidence: 99%

“…Efficacy studies for EVT primarily address BTA treatment, 14,40 or have implemented open-label designs or retrospective analyses to study pharmacological alternatives such as propranolol 26 or primidone. 41 Prospective studies that include strong experimental controls and objective measures of voice tremor are needed to determine the potential benefit of drug alternatives in EVT. Well-controlled, open-label, 18,42 and double-blind trials 17 of 1-octanol and OA have provided preliminary support for its ability to reduce magnitude of tremor in the limbs, but voice tremor was not addressed.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Octanoic Acid on Essential Voice Tremor: A Double‐Blind, Placebo‐Controlled Study

et al. 2018

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Objectives/Hypothesis The purpose of this study was to determine the effects of octanoic acid on acoustic, perceptual, and functional aspects of essential voice tremor (EVT). Study Design Prospective, double‐blind, placebo‐controlled, crossover study. Methods Sixteen participants with a diagnosis of EVT were randomized to a 3‐week dosing condition of octanoic acid or placebo, followed by a 2‐week washout period and crossover to the other condition for an additional 3 weeks. Baseline and post‐testing sessions were completed before and at the completion of each condition. Primary outcome measures were the magnitude of amplitude and frequency tremor, measured from the acoustic signal. Secondary outcomes were auditory‐perceptual ratings of tremor severity and self‐ratings of voice handicap. Results Magnitude of amplitude and frequency tremor were significantly lower after 3 weeks of octanoic acid dosing as compared to the placebo condition. Auditory‐perceptual ratings of tremor severity did not show significant differences between conditions. A trend toward better voice was seen for the sustained vowel ratings, but not the sentence‐level ratings. No significant differences between conditions were seen on self‐reported voice disability as assessed on the Voice Handicap Index‐10. Conclusions The results of this controlled investigation support the potential utility of octanoic acid for reducing the magnitude of tremor in people with EVT. Further research is needed to determine whether different dosing or treatment combinations can improve functional communication in EVT. Level of Evidence 1 Laryngoscope, 129:1882–1890, 2019

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Primidone Therapy for Essential Vocal Tremor

Abstract: Primidone therapy was an effective pharmacologic treatment for essential vocal tremor in 14 of 26 patients in this case series, providing an alternative to botulinum neurotoxin therapy.

Cited by 25 publications

References 20 publications

Essential tremor: diagnosis and management

Essential tremor: diagnosis and management

Chemodenervation of the Larynx

The Effect of Octanoic Acid on Essential Voice Tremor: A Double‐Blind, Placebo‐Controlled Study

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