Prospective, longitudinal analysis of medication use in a cohort of elderly essential tremor cases

Delgado, Nikki; Berry, Diane S.; Hernandez, Daniella Iglesias; Louis, Elan D.

doi:10.1016/j.jns.2022.120387

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…This These findings are consistent with previous studies conducted in the United States, which showed that nearly 27% to 44% of ET patients did not receive any specific treatment after diagnosis [22][23][24]. ET presentation is extremely variable in terms of clinical characteristics, tremor characteristics, and associated signs.…”

Section: Discussionsupporting

confidence: 91%

“…Despite its limited efficacy, pharmacological therapy remains the main therapeutic approach for treating patients with ET. However, information regarding the overall treatment patterns of ET patients is still scarce, is generally focused on US data, and is limited to small samples [8,[22][23][24][25]. We therefore conducted a retrospective cohort study aimed at describing the demographic and clinical characteristics of patients with ET, treatment patterns, and potential variables affecting the use of ET medications in two large cohorts of patients from France and the United Kingdom.…”

Section: Introductionmentioning

confidence: 99%

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Treatment patterns in essential tremor: Real‐world evidence from a United Kingdom and France primary care database

Antonazzo,

Rozza,

Conti

et al. 2023

Euro J of Neurology

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Background and purposeEssential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom.MethodsIncident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow‐up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow‐up, we assessed the daily prevalence of use and potential switches from first‐line to second‐line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment.ResultsA total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow‐up drug use decreased and at the end of the follow‐up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow‐up, nearly 20% switched, and 40%–75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication.ConclusionThis study shows that ET is an undertreated disease with a lower‐than‐expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Treatment patterns in essential tremor: Real‐world evidence from a United Kingdom and France primary care database

Antonazzo,

Rozza,

Conti

et al. 2023

Euro J of Neurology

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“…Evidence has showed positive effects of counseling and education on chronic illness such as diabetes and cardiovascular [28]. Furthermore, given the limited efficacy of available medicine for ET and the observed more homogeneous treatment strategies in China, physicians are suggested to engage in a continuous process of feedback and make adjustment accordingly to achieve a satisfactory therapeutic outcome, which was supported by the observed continuous change of patients’ prescriptions regarding medication types and/or doses reported in a prospective study [29]. This approach underscores the importance of closely monitoring patients' feedback and keeping in line with updated guidelines.…”

Section: Discussionmentioning

confidence: 97%

Medication Status and Related Factors in Essential Tremor Patients: A Cross-Sectional Study in China

Lin¹,

Zhou²,

He³

et al. 2023

Neuroepidemiology

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Introduction: Essential Tremor (ET) is one of the most common movement disorders. Oral drugs play a crucial role in treating ET, with various available options such as propranolol, primidone and topiramate. However, the medication status and related factors among Chinese ET patients are unknown yet. Methods: This study used the baseline data from the National Survey of Essential Tremor Plus in China cohort. ET patients with information related to medication intake were included. Medication patients was defined as patients who were taking medication at the time of the survey. We further defined recommended medication users according to Chinese guideline recommendations and clinical knowledge. We used mean and standard deviation (SD), median and interquartile range (IQR), or frequencies and percentages when appropriate for descriptive analysis. We used multivariate logistic regression analyses to explore factors related to medication intake in all ET patients, and in recommended medication users respectively. Results: Of 1153 included ET participants, 207 (18.0%) took medication. Arotinolol (115, 55.6%) and propranolol (63, 30.4%) were the top 2 used medicines. Patients with middle school education (odds ratio 0.57, 95% confidence interval 0.39 to 0.83), college or higher level education (0.46, 0.28 to 0.76) and late onset ET (LO-ET) (0.38, 0.23 to 0.63) were less likely to take medication. Patients with intention tremor (1.90, 1.38 to 2.62), every 10-unit increase in age (1.10, 1.00 to 1.21), Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS) Part 1 (1.63, 1.37 to 1.93), and TETRAS Part 2 (1.81, 1.48 to 2.22) were more likely to take medication. Among 332 recommended medication users, only 104 (31.3%) took medicine. The associations of LO-ET (0.36, 0.17 to 0.75), intention tremor (2.27, 1.35 to 3.81), TETRAS Part1 (1.52, 1.09 to 2.13) and TETRAS Part 2 (1.59, 1.15 to 2.20) with medication were similar to all ET patients. Conclusion: The proportion of medication intake is low among both all ET patients and recommended medication users. The top two commonly used medications among all ET patients are arotinolol and propranolol. Influencing factors of medication intake are different between all ET patients and recommended medication users. Clinicians are suggested to provide counseling and education on ET medication to promote medication intake.

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“…It is metabolized to phenobarbital and phenylethylmalonamide by CYP2C9, CYP2C19, and CYP2E1 enzymes[ 22 ]. Primidone is still prescribed for patients with epilepsy; but it has some other certain indications such as essential tremor as well[ 60 ]. It has a high bioavailability (> 90%) with a low plasma protein binding (10%)[ 59 ].…”

Section: Asms With the High Potential Of Liver Injurymentioning

confidence: 99%

Potential risk of liver injury in epileptic patients during COVID-19 pandemic

Tabrizi¹,

Sharifi-Razavi²

2022

World J Virol

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Most of the antiseizure medications (ASMs) are metabolized in liver and many of them particularly first-generation ASMs have the potential to increase liver enzymes or induce liver injury. Hence, treatment of new onset seizures or epilepsy by ASMs during the course of coronavirus disease 2019 (COVID-19), which could potentially be complicated by hepatic dysfunction, is a challenging clinical issue. Intravenous form of levetiracetam which has no significant hepatic metabolism or drug-drug interaction is often a favorable option to control seizures in acute phase of COVID-19. Administration of enzyme inducer ASMs and valproate with the well-known hepatotoxicity and common drug interactions is not generally recommended. In patients with epilepsy who are under control with potentially hepatotoxic ASMs, close observation and cautious dose reduction or drug switch should be considered if any evidence of hepatic impairment exists. However, risks of possible breakthrough seizures should be weighed against benefits of lowering the hazard of liver injury. In patients with epilepsy who receive polytherapy with ASMs, transient dose modification with the tendency to increase the dose of ASMs with more favorable safety profile and less drug interaction and decrease the dose of drugs with main hepatic metabolism, high protein binding, potential to cause liver injury and known drug-drug reaction should be considered. Finally, decision making should be individualized based on patients’ conditions and course of illness.

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Prospective, longitudinal analysis of medication use in a cohort of elderly essential tremor cases

Cited by 6 publications

References 24 publications

Treatment patterns in essential tremor: Real‐world evidence from a United Kingdom and France primary care database

Treatment patterns in essential tremor: Real‐world evidence from a United Kingdom and France primary care database

Medication Status and Related Factors in Essential Tremor Patients: A Cross-Sectional Study in China

Potential risk of liver injury in epileptic patients during COVID-19 pandemic

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