Treatment of patients with essential tremor

Deuschl, Günther; Raethjen, Jan; Hellriegel, Helge; Elble, Rodger J.

doi:10.1016/s1474-4422(10)70322-7

Cited by 357 publications

(356 citation statements)

References 147 publications

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“…A common form of kinetic (intention) tremor is cerebellar tremor related to multiple sclerosis (MS), but there are other etiologies of cerebellar tremor. In this review, which extends earlier analyses [8,9], we will concentrate on the common forms.…”

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confidence: 87%

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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confidence: 87%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…The central oscillating constituents of the network comprise parts of the physiological central motor system . There is both neurophysiological and clinical evidence of thalamic involvement in the central oscillatory network generating essential tremor (Hirai et al, 1983, Hubble et al, 1996, Marsden et al, 2000, Vaillancourt et al, 2003, Lyons and Pahwa, 2004, Hua and Lenz, 2005, Deuschl et al, 2011. Local field potential (LFP) recordings of thalamic ventralis intermedius (Vim) nucleus show strong linear correlation with the contralateral EMG during tremor (Marsden et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Nonlinear interactions in the thalamocortical loop in essential tremor: A model-based frequency domain analysis

Sarrigiannis

Billings

et al. 2016

Neuroscience

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractThere is increasing evidence to suggest that essential tremor has a central origin. Different structures appear to be part of the central tremorogenic network, including the motor cortex, the thalamus and the cerebellum. Some studies using EEG and MEG show linear association in the tremor frequency between the motor cortex and the contralateral tremor EMG.Additionally, high thalamomuscular coherence is found with the use of thalamic local field potential (LFP) recordings and tremulous EMG in patients undergoing surgery for deep brain stimulation (DBS). Despite a well-established reciprocal anatomical connection between thalamus and cortex, the functional association between the two structures during "tremor- Highlights• We use a nonlinear autoregressive exogenous model to de-codify corticothalamic communication• We reveal nonlinear interactions between motor cortex and thalamus in essential tremor• We define corticothalamic interactions during tremor active and rest states• There are state specific frequencies and time lags in corticothalamic interrelationships

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“…Thus, primidone should be started at very low doses (i.e. 25 mg or even 12.5 mg) and half a quarter of the tablet it should be taken at bedtime to avoid side effects (dizziness and sedation) (3)(4)(5). Then, the dose can be increased to 250 mg every third day, until the symptoms are controlled or the maximum tolerated dose is reached in adults.…”

Section: Discussionmentioning

confidence: 99%

“…Its side effects are common and generally dose dependent. The number and rate of side effects may become more prominent as the dose of the medication is increased (4,5).…”

Section: Introductionmentioning

confidence: 99%

Altered Consciousness and Atrial Fibrillation due to Primidone Intake

Köse¹,

Bozkurt²,

Çelik³

et al. 2015

EAJEM

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Primidone is an anticonvulsant drug taken for the treatment of essential tremor. Side effects may become more pronounced with increasing doses. However, atrial fibrillation as a side effect of the drug has neither been reported in literature nor is it specifically indicated by the package insert. Here we would like to report a patient who developed sedation, confusion, and atrial fibrillation after primidone use. A 68-year-old woman presented to our emergency department with nausea, vomiting, perspiration, and somnolence some time after taking primidone (Mysoline) 250 mg. It was learnt that Mysoline 62.5 mg (a quarter of the 250 mg tablet) had been prescribed by a neurologist for treating essential tremor 2-3 weeks before, although the patient had inadvertently taken a tablet per day. An admission electrocardiography (ECG) at the emergency department showed atrial fibrillation with a rapid ventricular response. The cardiology and neurology departments agreed that the atrial fibrillation episode was a side effect of primidone. It is recommended to instruct patients on and warn them against the side effects when primidone is taken for the first time. It should be kept in mind that in elderly patients presenting to emergency departments, drugs such as primidone, which may cause sedation, confusion, and atrial fibrillation, may be the cause. (Eurasian J Emerg Med 2015; 14: 151-3)

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Treatment of patients with essential tremor

Cited by 357 publications

References 147 publications

The Treatment of Tremor

The Treatment of Tremor

Nonlinear interactions in the thalamocortical loop in essential tremor: A model-based frequency domain analysis

Altered Consciousness and Atrial Fibrillation due to Primidone Intake

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