The Treatment of Tremor

Abstract

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.

‘YES YES HEAD TREMOR’ case developing after cerebellar infarction

“…Daha nadir olarak; topiramat, gabapentin, klonazepam, sodium valproat, lisurid, levetirasetam, antikolinerjikler ve levodopa kullanılmaktadır (3,4). Botilinium toksin uygulaması sonrası başarı elde edilmiş olgular da bildirilmiştir (4).…”

Neurological manifestations in Wilson’s disease –possible treatment options for symptoms

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Therefore, such treatments should also be considered as potentially effective in patients with WD, especially those with severe neurological presentations who are not responding to or perhaps even deteriorating while receiving anticopper therapy. However, so far only case reports have been published describing such therapy in patients with WD (Table 1).…”

Permanent reversal of essential tremor following a frontal lobe stroke

“…It usually manifests as postural and action tremor of the arms, but may also involve the head, voice, lower limbs and trunk [10]. Since pharmacological agents have limited benefits, surgical interventions are the last resort in the most disabling cases [10]. Numerous studies support the presence of a neural network at the basis of ET generation.…”