Relationship between plasma propranolol concentration and relief of essential tremor.

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

doi:10.1136/jnnp.42.9.831

Cited by 48 publications

(11 citation statements)

References 23 publications

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“…However, all these studies showed a great deal of interindividual variation, although results were reproducible within individual subjects. Of interest is that the maximum decrease in symptoms in patients with essential tremor appears to be concentration-dependent and also occurs at or below I OOngl ml (Jefferson et al, 1979;McAllister et aI., 1977).…”

Section: Therapeutic Plasma Levelsmentioning

confidence: 97%

Therapeutic Drug Monitoring of Antiarrhythmic Agents

Brown

Shand

1982

Clinical Pharmacokinetics

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Therapeutic drug monitoring has come of age in clinical medicine and, in particular, its use with antiarrhythmic agents has flourished. The classic indications for the use of therapeutic drug monitoring are commonly encountered with antiarrhythmic drug use. Most of the currently available allliarrhythmics have a narrow therapeutic index, necessitating car~ful dose titration. The ~rfectiveness of these agents in clinical use isfrequent(v d([ficultlo determine as a result of marked variability in arrhythmia frequency or i l1 frequelll events. Thus, therapeutic drug monitoring seems appropriate for adjusting therapy in arrhythmia prophylaxis or in the prevention (if sudden death. Most antiarrhythmic agents appear to have generally accepted therapeutic ranges, a prerequisite for therapeutic drug monitoring. The historical determina' tion of the therapeutic range for each of the allliarrhythmics will be discussed in addition 10 the numerous factors affecting the d~finition (if this range for any drug, including type (if arrhythmia, aetiology of underlying cardiac disease, the concept (if true individual dose ranging, adequate control periods, the definition of true drug efficacy and the quantitation (if arrhythmia frequency (including 24-hour ECG recording with computer-assisted analysis and the invasive technology (if programmable velllricular stimulation), and the roles of protein binding, drug interactions and active metabolites.In addition to these considerations, therapeutic drug monitoring is particularly us~ful in this drug class because of marked illlerindividual variability in pharmacokinetic parameters including absorption, clearance and volume of distribution, resulting in variable dose-concelli ration relationships. This information can be useful in distinguishing between true therapeutic failures and inadequate plasma concelllrations.The therapeutic concentration range of quinidine appears to be 1 to 5pg/mlutilising newer, more specific assay techniques, but the accepted range is very dependent on the type of assay. There is wide interindividual variability in the optimal drug concentration with toxicity occurringfrom Jpg/ml. The ~[feclive concentration range for procainamide is 4 to 10pg/ml, with early toxicity commencing at 8 to IOllg/ml and progressively increasing with further increments in plasma concentration. However, some patients may respond to higher concelllrations without experienCing toxicity. The therapeutic concentration range for N-acetylprocainamide is not clearly defined, but appears to be greater than IOpg/ ml with toxicity occurring over a wide range (if concelllrations (10 to 40pg/ ml). As yet, there is no sati~factory method to deal with combined procainamide and N-acetylprocainamide concentrations.

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Section: Therapeutic Plasma Levelsmentioning

confidence: 97%

Therapeutic Drug Monitoring of Antiarrhythmic Agents

Brown

Shand

1982

Clinical Pharmacokinetics

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“…Propranolol has been effective in re ducing tremor in two thirds of the patients. For the remaining one third of the patients with severe essential tremor, stereotactic surgery re presents a valuable method to treat the disorder [6,10], …”

Section: Introductionmentioning

confidence: 99%

Long-Term Results of Stereotaxy in the Treatment of Essential Tremor

Mohadjer

Goerke

Milios

et al. 1990

Stereotact Funct Neurosurg

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In patients with severe tremor that is resistant to drug therapy, stereotactic coagulation can achieve a satisfactory and lasting reduction of the movement disorders. Very few long-term studies have been conducted following stereotactic operations. From 1964 to 1984, 104 patients with a diagnosis of essential tremor were operated on in the Division of Stereotaxy and Neuronuclear Medicine. After an average follow-up period of 8.6 years, 65 patients were examined. In 80%, the success of the stereotactic operation was still evident. Complete disappearance or substantial reduction of the tremor was determined in 69% and moderate improvement in 11.9% of the patients.

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“…Twelve scales have been assessed for tremor evaluation ( [3,4,5,23,25,41,43,44,54,71,101,116] (Table 1), but only two of them, the FahnTolosa-Marin Tremor Rating Scale (FTM-TRS) and the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET), reached recommendation status ( [23]. This scale also evaluates voice tremor as well as handwriting and other tasks, such as hygiene and dressing, assessing the impact of tremor on patients' daily life.…”

Section: Tremormentioning

confidence: 99%

Scales for hyperkinetic disorders: A systematic review

Pietracupa

Bruno

Cavanna

et al. 2015

Journal of the Neurological Sciences

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Hyperkinetic movement disorders represent a heterogeneous group of disorders in which involuntary movements are the prevalent clinical symptoms. The five main categories of hyperkinetic disorders are tremor, dystonia, tics,myoclonus and drug-induced dyskinesia.The severity of hyperkinetic disorders is assessed by all clinicians when they examine a patient; quantifying the severity also provides a means of studying the natural history of a given disorder and the possible effect of new therapeutic interventions. This means that good rating instruments are required in both everyday practice and experimental settings. Unfortunately, the clinical evaluation of these disorders is complicated by the inherent nature and variability over time of involuntary movements. A number of scales have been proposed over the years to study the various hyperkinetic disorders. The aim of this review is to systematically identify all the clinical scales that have been proposed and to classify them according to the criteria developed by the Movement Disorder Society (MDS) task force for rating scales in Parkinson's disease.On the basis of this methodology, a scale may be defined as 'Recommended', 'Suggested' or 'Listed' in decreasing order of value.We found that, although numerous scales aimed at assessing hyperkinetic disorders have been published, their variability in terms of clinimetric properties, availability and effort required to administer them is high. In this evaluation, we identified scales defined as 'Recommended' for the assessment of all forms of hyperkinetic disorders. The situation highlighted by our analysis varies considerably, with several 'Recommended' scales being available for some conditions such as tics or dystonia, but only one being available for myoclonus. This gap needs to be filled by the scientific community through both the development of new clinical tools and there finement of existing ones.

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Relationship between plasma propranolol concentration and relief of essential tremor.

Cited by 48 publications

References 23 publications

Therapeutic Drug Monitoring of Antiarrhythmic Agents

Therapeutic Drug Monitoring of Antiarrhythmic Agents

Long-Term Results of Stereotaxy in the Treatment of Essential Tremor

Scales for hyperkinetic disorders: A systematic review

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