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Hernandez AB, Berry DS, Grill N, Hall TM, Burkes A, Ghanem A, Sharma VD, Louis ED. WHIGET and TETRAS Ratings of Action Tremor in Patients with Essential Tremor: Substantial Association and Agreement. Tremor Other Hyperkinet Mov (N Y) 2024; 14:14. [PMID: 38550904 PMCID: PMC10976980 DOI: 10.5334/tohm.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
Background Evaluating tremor severity is a critical component of diagnosing and clinically managing patients with essential tremor (ET). We examined the comparability of tremor severity ratings derived from two frequently used tremor rating scales: the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) rating scale and the Tremor Research Group Essential Tremor Rating Scale (TETRAS). Methods A trained assistant administered and videotaped a neurological examination, including eight items assessing upper limb action tremor (arms outstretched, arms in the wingbeat position, finger-nose-finger maneuver, and drawing of Archimedes spirals). An experienced movement disorders neurologist reviewed the videos and assigned WHIGET and TETRAS ratings. We calculated associations between TETRAS and WHIGET ratings using Spearman rank order correlations. Subsequently, we collapsed these ratings into four tremor severity categories (absent, mild, moderate, severe) and then two broader tremor severity categories (absent/mild, moderate/severe). We calculated weighted Kappa coefficients to assess agreement between category assignments based on the TETRAS and the WHIGET. Results Spearman's r' s were significant for all items (p's ≤ 0.001, mean r = 0.89). Weighted Kappa's revealed substantial to near perfect agreement for all eight items (mean k = 0.86, range = 0.64 to 1.00). Conclusion Analyses revealed substantial strength of association and substantial to near perfect agreement between items rated with the WHIGET and TETRAS scales. These data indicated that ratings provided by each scale are highly comparable.
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Affiliation(s)
| | - Diane S. Berry
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Natalie Grill
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Talía M. Hall
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allison Burkes
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ali Ghanem
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vibhash D. Sharma
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elan D. Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Louis ED, Eliasen EH, Ferrer M, Iglesias Hernandez D, Gaini S, Jiang W, Zheng W, Nielsen F, Petersen MS. Blood Harmane (1-Methyl-9H-Pyrido[3,4-b]indole) and Mercury in Essential Tremor: A Population-Based, Environmental Epidemiology Study in the Faroe Islands. Neuroepidemiology 2020; 54:272-280. [PMID: 32007995 PMCID: PMC7210050 DOI: 10.1159/000505874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Essential tremor (ET) is among the most prevalent neurological diseases. Its environmental determinants are poorly understood. Harmane (1-methyl-9H-pyrido[3, 4-b]indole), a dietary tremor-producing neurotoxin, has been linked to ET in a few studies in New York and Madrid. Mercury, also a tremor-producing neurotoxin, has not been studied in ET. The Faroe Islands have been the focus of epidemiological investigations of numerous neurological disorders. OBJECTIVE In this population-based, case-control study, we directly measured blood harmane concentrations (HA) and blood mercury concentrations (Hg) in ET cases and controls. METHODS In total, 1,328 Faroese adults were screened; 26 ET cases were identified whose (HA) and (Hg) were compared to 197 controls. RESULTS Although there were no statistically significant differences between diagnostic groups, median (HA) was 2.7× higher in definite ET (4.13 g-10/mL) and 1.5× higher in probable ET (2.28 g-10/mL) than controls (1.53 g-10/mL). Small sample size was a limitation. For definite ET versus controls, p = 0.126. (Hg) were similar between groups. CONCLUSIONS We demonstrated marginally elevated (HA) in definite and probable ET. These data are similar to those previously published and possibly extend etiological links between this neurotoxin and ET to a third locale. The study did not support a link between mercury and ET.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA,
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA,
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut, USA,
| | - Eina H Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faeroe Islands
| | - Monica Ferrer
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Shahin Gaini
- Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faeroe Islands
- Infectious Diseases Division, National Hospital Faroe Islands, Tórshavn, Faeroe Islands
- Department of Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | - Wendy Jiang
- Purdue University School of Health Sciences, West Lafayette, Indiana, USA
| | - Wei Zheng
- Purdue University School of Health Sciences, West Lafayette, Indiana, USA
| | - Flemming Nielsen
- Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faeroe Islands
- Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faeroe Islands
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Alonso-Navarro H, García-Martín E, Agúndez JA, Jiménez-Jiménez FJ. Current and Future Neuropharmacological Options for the Treatment of Essential Tremor. Curr Neuropharmacol 2020; 18:518-537. [PMID: 31976837 PMCID: PMC7457404 DOI: 10.2174/1570159x18666200124145743] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/31/2019] [Accepted: 01/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Essential Tremor (ET) is likely the most frequent movement disorder. In this review, we have summarized the current pharmacological options for the treatment of this disorder and discussed several future options derived from drugs tested in experimental models of ET or from neuropathological data. METHODS A literature search was performed on the pharmacology of essential tremors using PubMed Database from 1966 to July 31, 2019. RESULTS To date, the beta-blocker propranolol and the antiepileptic drug primidone are the drugs that have shown higher efficacy in the treatment of ET. Other drugs tested in ET patients have shown different degrees of efficacy or have not been useful. CONCLUSION Injections of botulinum toxin A could be useful in the treatment of some patients with ET refractory to pharmacotherapy. According to recent neurochemical data, drugs acting on the extrasynaptic GABAA receptors, the glutamatergic system or LINGO-1 could be interesting therapeutic options in the future.
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Affiliation(s)
| | | | | | - Félix J. Jiménez-Jiménez
- Address correspondence to this author at the Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain; Tel: +34636968395; Fax: +34913280704; E-mails: ;
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Louis ED, Ferrer M, Eliasen EH, Gaini S, Petersen MS. Tremor in normal adults: A population-based study of 1158 adults in the Faroe Islands. J Neurol Sci 2019; 400:169-174. [PMID: 30954661 DOI: 10.1016/j.jns.2019.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/25/2019] [Accepted: 03/20/2019] [Indexed: 12/27/2022]
Abstract
There are virtually no population-based data on tremor in normal individuals. Using a population-based sample of 1158 normal adults ages 40-98 years in the Faroe Islands, we characterized the extent of normal action tremor across age and gender strata. Participants drew two Archimedes spirals with each hand, and tremor was systematically quantified by a senior movement disorder neurologist using a reliable and valid ordinal rating scale (ratings = 0-3). Tremor was nearly universal - 1145 (98.9%) participants had a total mean spiral score > 0. Older age was associated with more tremor (p < .001) and spiral scores were higher in males than females (p < .001). The proportion of individuals with a spiral rating ≥ 1.5 (i.e., more than mild tremor) was low (1.8% - 8.5%); however, this value reached 19.6% in left-hand spirals of males ≥70 years old. In this population-based study of more than one thousand normal adults, the vast bulk (i.e., 98.9%) had tremor on spiral drawing. In general, the tremor was mild. The proportion of individuals with tremor above the mild range varied across age and gender strata. These extensive data may be used as a gold standard for defining normal levels of tremor within adult populations.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Monica Ferrer
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Eina H Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Shahin Gaini
- Infectious Diseases Division, National Hospital Faroe Islands, Tórshavn, Faroe Islands; Department of Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark; Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands; Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
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Eliasen EH, Ferrer M, Gaini S, Louis ED, Petersen MS. Prevalence of Essential Tremor in the Faroe Islands: A Population-Based Study. Neuroepidemiology 2019; 52:227-236. [PMID: 30889566 DOI: 10.1159/000499070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND No studies of the prevalence of one of the most common movement disorders, essential tremor (ET), have been undertaken in the Faroe Islands. Given the potential for founder effects in the Islands, and the highly genetic nature of ET, the Faroe Islands provide a particularly interesting setting in which to study the prevalence of ET. OBJECTIVE To estimate the prevalence of ET and study its characteristics. METHODS We used a 2-phase, population-based design, screening 1,328 randomly selected Faroese individuals aged ≥40 years. A subsample of 282 individuals who had returned the spirals and questionnaire was selected to participate in an in-person clinical evaluation. Tremor was systematically quantified by a senior movement disorder neurologist with particular specialization in tremor using a reliable and valid clinical rating scale followed by the application of rigorous diagnostic criteria used by tremor investigators internationally. RESULTS The overall crude prevalence was 2.9%. The age-adjusted prevalence was 3.1%. There was an age-associated rise in prevalence; by age ≥70, prevalence reached 4.8%. Twenty six of 27 (96.2%) were previously undiagnosed. CONCLUSIONS This is the first population-based study of the prevalence of ET in the Faroe Islands. The estimated prevalence was similar to studies using the same or comparable methodologies.
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Affiliation(s)
- Eina H Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital Systems, Tórshavn, Faeroe Islands,
| | - Monica Ferrer
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Shahin Gaini
- Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faeroe Islands.,Infectious Diseases Division, National Hospital Faroe Islands, Tórshavn, Faeroe Islands.,Department of Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital Systems, Tórshavn, Faeroe Islands.,Centre for Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faeroe Islands
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Validity of probands' reports and self-reports of essential tremor: Data from a large family study in North America. J Neurol Sci 2018; 393:45-50. [PMID: 30103063 DOI: 10.1016/j.jns.2018.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/02/2018] [Accepted: 08/03/2018] [Indexed: 02/01/2023]
Abstract
The search for genes for essential tremor (ET) is active. Researchers often depend on probands' reports or self-reports to assign disease status to relatives. Yet there are surprisingly few data on the validity of these reports. In two prior studies, with small sample sizes, validity was poor (sensitivity = 16.7-43.3%). In the current study, ET probands and their relatives were screened for tremor and then underwent a videotaped in-person neurological examination. One investigator then assessed the screening questionnaires and videotapes to assign diagnoses of ET, borderline tremor or other diagnosis. There were 98 probands and 243 relatives (105 with ET, 34 with borderline tremor). Educational attainment was high (15.6 ± 2.7 years). Probands failed to report tremor in 39/139 relatives with ET or borderline tremor; conversely, they reported tremor in 32/104 relatives without ET or borderline tremor. Thus, in total, there were 71/243 (29.2%) mis-identifications. Thirty six of 139 ET and borderline ET cases failed to self-report tremor; conversely, 30/104 relatives without ET or borderline tremor self-reported tremor. Thus, in total, there were 66/243 (27.2%) mis-identifications. In summary, in individuals with greater educational attainment, the validity of reported information on ET was considerably higher than previously reported. Despite this, even among well-educated individuals in North America, probands' reports and self-reports misclassified approximately 30% (i.e., one-in-three) of relatives.
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Bruno E, Nicoletti A, Quattrocchi G, Allegra R, Filippini G, Colosimo C, Zappia M. Topiramate for essential tremor. Cochrane Database Syst Rev 2017; 4:CD009683. [PMID: 28409827 PMCID: PMC6478240 DOI: 10.1002/14651858.cd009683.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Essential tremor (ET) is one of the most common movement disorders. The management is primarily based on pharmacological agents and in clinical practice propranolol and primidone are considered the first-line therapy. However, these treatments can be ineffective in 25% to 55% of people and are frequently associated with serious adverse events (AEs). For these reasons, it is worthwhile evaluating other treatments for ET. Topiramate has been suggested as a potentially useful agent for the treatment of ET but there is uncertainty about its efficacy and safety. OBJECTIVES To assess the efficacy and safety of topiramate in the treatment of ET. SEARCH METHODS We carried out a systematic search without language restrictions to identify all relevant trials in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to January 2017), Embase (January 1988 to January 2017), National Institute for Health and Care Excellence (1999 to January 2017), ClinicalTrials.gov (1997 to January 2017) and World Health Organization International Clinical Trials Registry Platform (ICTRP; 2004 to January 2017). We searched BIOSIS Citation Index (2000 to January 2017) for conference proceedings. We handsearched grey literature and the reference lists of identified studies and reviews. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of topiramate versus placebo/open control or any other treatments. We included studies in which the diagnosis of ET was made according to accepted and validated diagnostic criteria. We excluded studies conducted in people presenting with secondary forms of tremor or reporting only neurophysiological parameters to assess outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently collected and extracted data using a data collection form. We assessed the risk of bias and the quality of evidence. We used a fixed-effect meta-analysis for data synthesis. MAIN RESULTS This review included three trials comparing topiramate to placebo (309 participants). They were all at high overall risk of bias. The quality of evidence ranged from very low to low. Compared to placebo, participants treated with topiramate showed a significant improvement in functional disability and an increased risk of withdrawal (risk ratio (RR) 1.78, 95% confidence interval (CI) 1.23 to 2.60). There were more AEs for topiramate-treated participants, particularly paraesthesia, weight loss, appetite decrease and memory difficulty. AUTHORS' CONCLUSIONS This systematic review highlighted the presence of limited data and very low to low quality evidence to support the apparent efficacy and the occurrence of treatment-limiting AEs in people with ET treated with topiramate. Further research to assess topiramate efficacy and safety on ET is needed.
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Affiliation(s)
- Elisa Bruno
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Alessandra Nicoletti
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Graziella Quattrocchi
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Roberta Allegra
- Policlinico Universitario G. Martino MessinaDepartment of Neurological SciencesVia Consolare ValeriaMessinaItaly90100
| | - Graziella Filippini
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Carlo Colosimo
- Terni University HospitalDepartment of NeurologyTerniItaly05100
| | - Mario Zappia
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
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Louis ED, Clark LN, Ottman R. Familial versus Sporadic Essential Tremor: What Patterns Can One Decipher in Age of Onset? Neuroepidemiology 2015; 44:166-72. [PMID: 25967236 DOI: 10.1159/000381807] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/22/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Essential tremor (ET) is a very prevalent neurological disease. Although familial and sporadic ET cases are assumed to have different age at onset distributions, no detailed study of this question has been carried out. METHODS Using a carefully characterized sample of 376 ET cases (232 (61.7%) familial) enrolled in a clinical-epidemiological study, we contrasted the age of onset distributions in familial versus sporadic ET. RESULTS Familial ET had a lower age at onset distribution, regardless of the current age. The majority (71 (86.6%) of 82) of ET cases that appeared during childhood were familial rather than sporadic. Additionally, the onset of ET occurred after age 40 in a majority of cases (125 (53.9%) of 232 with familial ET and 118 (81.9%) of 144 with sporadic ET), and in approximately one-quarter to one-half of cases, after age 60. CONCLUSIONS The age of onset of ET differs between familial and sporadic ET and furthermore, is variable within each of these groups. The onset of ET during childhood is usually familial, and the small number of identified exceptions could be due to de novo mutations. Understanding the heterogeneity in onset age will provide insights into the nature of underlying etiological and patho-biological processes about which little is presently known.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Conn., USA
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Louis ED, Rao AK. Tandem gait performance in essential tremor patients correlates with cognitive function. CEREBELLUM & ATAXIAS 2015; 1:19. [PMID: 26331043 PMCID: PMC4552146 DOI: 10.1186/s40673-014-0019-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/25/2014] [Indexed: 12/25/2022]
Abstract
Background Emerging yet separate literatures have highlighted gait/balance impairments (i.e., mild ataxia) and cognitive problems in patients with essential tremor (ET). However, the relationship between the two has not been studied. The goal of these analyses was to study the relationship between gait/balance impairments and cognitive problems in ET. One-hundred-twenty ET cases were enrolled in an epidemiological study at Columbia University Medical Center. A Telephone Interview for Cognitive Status (TICS, range = 0–41 [no deficits]) was administered and a videotaped assessment of tandem gait was performed, during which the number of missteps during 10-steps was counted. Results The mean TICS score was 35.7 (range 25–39), and mean number of tandem mis-steps was 2.9 (range 0–10). The number of tandem mis-steps was correlated with the TICS score (Spearman’s r = −0.245, p = 0.011, i.e., individuals who had more tandem gait difficulty also had more cognitive difficulty). In a multivariate analysis, tandem mis-steps were associated with TICS score (p = 0.04) independent of age and other factors. Conclusions More cognitive difficulty was associated with more tandem gait difficulty in ET. Ambulation often requires the concurrent use of both cognitive and motor neural systems; hence it is possible that the cognitive and gait problems in ET reflect an underlying pervasive disorder affecting both cognitive and motor circuits.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Ashwini K Rao
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Program in Physical Therapy, Department of Rehabilitation & Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY USA
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Zappia M, Albanese A, Bruno E, Colosimo C, Filippini G, Martinelli P, Nicoletti A, Quattrocchi G. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian Movement Disorders Association. J Neurol 2012; 260:714-40. [DOI: 10.1007/s00415-012-6628-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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Abstract
OBJECTIVE The primary objective of this article is to review the clinical presentation and pharmacologic management of essential tremor and tardive dyskinesia. DATA SOURCES The MEDLINE (1966-August 2005), Cochrane Database of Systematic Reviews, and International Pharmaceutical Abstracts (1970-August 2005) databases were searched for original research and review articles published in English. The search terms were essential tremor and tardive dyskinesia. Reference lists from articles were also consulted. DATA SYNTHESIS Essential tremor is most commonly manifested as a postural or action tremor of the upper extremities. Midline regions such as the head and voice are also commonly affected. Based on review of the literature, propranolol and primidone are the current pharmacologic mainstays for treating essential tremor of the upper extremities. The choice of agent depends on patient-specific factors such as underlying medical conditions. Other agents with demonstrated efficacy include gabapentin and topiramate. Benzodiazepines are effective adjunctive agents, but should be utilized judiciously in the elderly. Botulinum toxin is effective for essential tremor of the voice and head. Surgery is very effective, but may not be appropriate in the frail elderly and should be avoided in the presence of cognitive impairment. Tardive dyskinesia is characterized by involuntary choreoathetoid movements of the orofacial region. For the management of tardive dyskinesia, emphasis is placed on primary prevention and early recognition of signs and symptoms. In some cases, discontinuation of the offending agent can result in reversal of symptoms. If a conventional neuroleptic is the causative agent, switching to an atypical antipsychotic may be helpful. Overall, few treatments have proven to be consistently useful. Other agents that may be helpful include acetylcholinesterase inhibitors, amantadine, baclofen, benzodiazepines, branched chain amino acids, gabapentin, levetiracetam, pyridoxine, verapamil, and vitamin E. CONCLUSION Current pharmacologic agents for essential tremor can be expected to provide partial benefit. However, agents for the symptomatic management of tardive dyskinesia are limited, and additional research is warranted in this area.
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Affiliation(s)
- Jack J Chen
- School of Pharmacy, Loma Linda University, California 92350, USA.
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Abstract
Tremor in childhood is not commonly described in the literature; but it is also likely underappreciated. The etiology of childhood tremor encompasses a wide variety of pathologic processes. Tremor may occur in isolation, or in association with other neurologic findings or systemic disorders. This article aims to provide an overview of tremorogenic mechanisms with respect to neuroanatomy and neurophysiology, particularly as they relate to children. Classification of tremors, diagnostic entities in childhood, and treatment will also be discussed. With improved recognition and characterization of childhood tremors, we may gain a better understanding of the pathophysiology of the disease and determine more age-appropriate treatment strategies.
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Affiliation(s)
- Stephanie Keller
- Department of Pediatrics, Division of Child Neurology, University of Alabama at Birmingham, The Children's Hospital of Alabama, Birmingham, AL 35233, USA.
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Shank RP, Maryanoff BE. Molecular pharmacodynamics, clinical therapeutics, and pharmacokinetics of topiramate. CNS Neurosci Ther 2008; 14:120-42. [PMID: 18482025 PMCID: PMC6494007 DOI: 10.1111/j.1527-3458.2008.00041.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Topiramate (TPM; TOPAMAX) is a broad-spectrum antiepileptic drug (AED) that is approved in many world markets for preventing or reducing the frequency of epileptic seizures (as monotherapy or adjunctive therapy), and for the prophylaxis of migraine. TPM, a sulfamate derivative of the naturally occurring sugar D-fructose, possesses several pharmacodynamic properties that may contribute to its clinically useful attributes, and to its observed adverse effects. The sulfamate moiety is essential, but not sufficient, for its pharmacodynamic properties. In this review, we discuss the known pharmacodynamic and pharmacokinetic properties of TPM, as well as its various clinically beneficial and adverse effects.
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Affiliation(s)
- Richard P. Shank
- Research & Early Development, Johnson & Johnson Pharmaceutical Research & Development, Spring House, Pennsylvania 19477‐0776 USA
| | - Bruce E. Maryanoff
- Research & Early Development, Johnson & Johnson Pharmaceutical Research & Development, Spring House, Pennsylvania 19477‐0776 USA
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Kjellström S, Bruun A, Isaksson B, Eriksson T, Andréasson S, Ponjavic V. Retinal function and histopathology in rabbits treated with Topiramate. Doc Ophthalmol 2006; 113:179-86. [PMID: 17111186 DOI: 10.1007/s10633-006-9027-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate retinal function and histopathology in rabbits treated orally with the anti-epileptic drug topiramate. METHODS Six rabbits were treated with a daily oral dose of topiramate during a period of eight months. Six rabbits receiving water served as controls. Blood samples were analyzed for determination of topiramate serum levels in order to ensure successful drug exposition. Standardized full-field electroretinograms (ERGs) were performed before treatment and then at 2, 3 and 8 months during the treatment period. After terminating treatment the rabbits were sacrificed and the morphology of the sectioned retina was studied. RESULTS After eight months of treatment the full-field ERG demonstrated normal rod function in treated and control rabbits, but the light adapted 30 Hz flicker b-wave amplitude was significantly reduced in the treated rabbits. This was the case for both the light adapted (Wilcoxon signed ranks test, P = 0.046) and the dark adapted (Wilcoxon signed ranks test, P = 0.028) 30 Hz flicker response from the treated rabbits. Retinal immunohistology revealed a severe accumulation of GABA in amacrine cells and in the inner plexiform layer in 4 of 6 treated rabbits compared to the controls. CONCLUSIONS Topiramate, orally administrated to rabbits, may cause a significant reduction of the retinal function demonstrated by the reduced b-wave amplitude in the full-field ERG, as well as changes in immunohistology characterized by a severe accumulation of GABA in the inner retina. The retinal dysfunction and the morphological changes indicate that topiramat may damage the retina, similarly to vigabatrin (another anti-epileptic drug).
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Affiliation(s)
- S Kjellström
- Department of Ophthalmology, University of Lund, S 221 85, Lund, Sweden
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Alonso-Navarro H, Jiménez-Jiménez FJ. Reversible tremor, myoclonus, and fasciculations associated with topiramate use for migraine. Clin Neuropharmacol 2006; 29:157-9. [PMID: 16772816 DOI: 10.1097/01.wnf.0000220825.65393.93] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report a patient with tremor, multifocal myoclonus, and fasciculations, possibly induced by the antiepileptic drug topiramate. CASE REPORT A 46-year-old woman with frequent episodes of migraine without aura that were not controlled with other prophylactic drug, developed a reversible clinical picture of postural tremor, multifocal myoclonus, weight loss, amyotrophia, and fasciculations after exposure to topiramate. These symptoms disappeared after topiramate withdrawal. CONCLUSIONS Tremor, myoclonus, and fasciculations should be considered as a possible adverse effect of topiramate.
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Gatto EM, Roca CU, Raina G, Gorja M, Folgar S, Micheli FE. Reply: Vascular hemichorea/hemiballism and topiramate. Mov Disord 2006. [DOI: 10.1002/mds.20783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Tremor is often a disabling primary condition or secondary to another disorder. No universally effective pharmacological agent exists for the treatment of essential tremor, and patients differ greatly in their response to therapies, thus requiring individualised regimens. Deep brain stimulation is the best option for patients with disabling, drug-resistant essential tremor. Resting tremor in Parkinson's disease is usually not the primary disabling feature, and in most cases, levodopa/carbidopa is satisfactory for many years. Young Parkinson's patients with dominant, disabling tremor benefit from anticholinergics in addition to dopaminergic therapies. However, older Parkinson's patients with more disabling tremor may suffer from dose-dependent side effects, and deep brain stimulation should be considered. This article outlines the available pharmacological agents and treatment considerations for various disabling tremors, including essential tremor and Parkinson's disease.
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Frima N, Grünewald RA. A Double-blind, Placebo-controlled, Crossover Trial of Topiramate in Essential Tremor. Clin Neuropharmacol 2006; 29:94-6. [PMID: 16614542 DOI: 10.1097/00002826-200603000-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The antiepileptic drug topiramate has been reported to improve essential tremor, but clinical trials have been small and of unsatisfactory design. We undertook a double-blind, placebo-controlled crossover study of topiramate in essential tremor, using accelerometry, spirography, and an activities of daily living questionnaire. Sixteen subjects were recruited between January and June 2002. Three withdrew consent, 13 commenced the study, and 10 finished it. Subjects were assessed at baseline and after 2, 4, and 6 weeks of treatment (placebo or topiramate doses 25, 50, and 100 mg daily). Following a washout period of 1 week, patients crossed over to the alternate arm of the study. Statistical analysis followed the method described by Altman. There was no period effect or treatment-period interaction. No outcome measure improved significantly in the active treatment period as compared with the placebo control period, although 4 of the 10 patients improved in at least 2 of the 3 outcome measures during the active treatment phase, and none during the control treatment phase. This study provided no evidence of therapeutic benefit of topiramate in essential tremor. A marginally larger study would be required formally to exclude a useful therapeutic effect. To achieve a study with a power of 80% to exclude the null hypothesis, at least 17 patients would be required using accelerometry, 19 using spirography, and 2,00 using an activities of daily living questionnaire.
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Rincon F, Louis ED. Benefits and risks of pharmacological and surgical treatments for essential tremor: disease mechanisms and current management. Expert Opin Drug Saf 2006; 4:899-913. [PMID: 16111452 DOI: 10.1517/14740338.4.5.899] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Essential tremor (ET) is a neurological disease (and possibly a family of diseases) whose most recognisable feature is an action tremor of the hands and occasionally of the voice and head. Current data support the view that CNS gamma-amino-butyric acid (GABA)-ergic mechanisms may underlie ET and that the tremor may be further modulated by peripheral (muscle) adrenoreceptors. Potential pharmacotherapeutic options, targeted to influence the activity of the neurotransmitter GABA within the CNS and the peripheral adrenergic receptors, are part of the current armamentarium to treat ET. As such, primidone and propranolol remain the mainstays of the therapy for ET. Intramuscular injections of botulinum toxin A may play a role in the treatment of voice and head tremor. Surgical options, which are reserved for patients with severe, medically-refractory tremor, provide adequate tremor control in the majority of patients. As with other progressive neurological disorders of late life, the ability to use neuroprotective medications to intervene in the developing disease to either slow or halt the progression of the pathological process, would involve an understanding of underlying disease mechanisms. The understanding of these mechanisms in ET is limited and further study of these mechanisms is critical for the development of such therapies.
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Affiliation(s)
- Fred Rincon
- Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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