topiramate and Essential-Tremor

Tremor may be defined as an involuntary movement that is rhythmic (ie, regularly recurrent) and oscillatory (ie, rotating around a central plane) and may manifest in a variety of ways; accordingly, tremor has a rich clinical phenomenology. Consequently, the diagnosis of tremor disorders can be challenging, and misdiagnoses are common. The goal of this article is to provide the reader with straightforward approaches to the diagnosis and treatment of tremors.. Focused ultrasound thalamotomy of the ventral intermediate nucleus of the thalamus is an emerging and promising therapy for the treatment of essential tremor.. The evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the primary tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, primary writing tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common disorder of resting tremor. This article details the clinical features of each of these disorders, as well as those of additional tremor disorders.

Topics: Aged; Diagnosis, Differential; Dystonia; Essential Tremor; Female; Humans; Middle Aged; Topiramate; Tremor; Ventral Thalamic Nuclei

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.. To assess the efficacy and safety of topiramate in the treatment of ET.. 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.. 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.. 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.. 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.. 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.

Topics: Activities of Daily Living; Anticonvulsants; Essential Tremor; Fructose; Humans; Patient Dropouts; Publication Bias; Randomized Controlled Trials as Topic; Topiramate

Essential tremor (ET) is the most common movement disorder that is frequently treated by propranolol or primidone. However, 30% of patients with ET do not respond to either propranolol or primidone. The objective of this study was to assess the efficacy and safety of topiramate for ET.We searched the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials on the effects of topiramate for ET. A meta-analysis technique was applied to estimate the efficacy and safety of topiramate. The primary outcome was the change in the Fahn-Tolosa-Marin tremor rating scale (TRS). The secondary outcomes included the respective change in the location, motor tasks/function and function disability scores, and adverse events.We included 3 randomized controlled trials with a total of 294 participants. Topiramate was significantly better than placebo in reducing TRS of patients with ET (mean difference [MD] -8.58, 95% confidence interval [CI] -15.46 to -1.70). Changes from the scales of upper limb tremor severity (MD -5.12, 95% CI -7.79 to -2.45), motor tasks/function (MD -5.07, 95% CI -7.12 to -3.03), and functional disability (MD -4.72, 95% CI -6.77 to -2.67) were significantly greater with topiramate than with placebo. More participants taking topiramate experienced adverse events leading to withdrawal than those taking placebo (risk difference 19%, 95% CI 11%-27%).There is consistent evidence supporting the efficacy of topiramate in treating ET; however, a significant proportion of participants withdrew due to its adverse effects.

Topics: Anticonvulsants; Essential Tremor; Fructose; Humans; Randomized Controlled Trials as Topic; Topiramate

Essential tremor is the most common adult movement disorder. Traditionally considered as a benign disease, it can cause an important physical and psychosocial disability. Drug treatment remains poor and often unsatisfactory. Current therapeutical strategies are reviewed according to the level of discomfort caused by tremor: mild tremor, non-pharmacological strategies, alcohol, acute pharmacological therapy; moderate tremor, pharmacological therapies (propranolol, gabapentin, primidone, topiramate, alprazolam and other drugs), and severe tremor, the role of functional surgery is emphasized (thalamic deep brain stimulation, thalamotomy). It is also described the more specific treatment of head tremor with the use botulinum toxin. Finally, several points are exposed to guide the immediate research of this disease in near future.

Topics: Adult; Aged; Alprazolam; Amines; Antipsychotic Agents; Botulinum Toxins, Type A; Calcium Channel Blockers; Cyclohexanecarboxylic Acids; Deep Brain Stimulation; Essential Tremor; Fructose; Gabapentin; gamma-Aminobutyric Acid; Head Movements; Humans; Middle Aged; Primidone; Propranolol; Severity of Illness Index; Thalamus; Topiramate; Tranquilizing Agents; Voice Disorders

Tremors can be encountered in a variety of disease states but the most common causes are Parkinson disease and essential tremor. This review was undertaken to highlight advances in the field during the last 12 months.. Kinetic tremor may be more prominent in essential tremor than postural tremor. Clinically Parkinson disease and essential tremor may be confused with each other but it may be possible to distinguish between these two nitrites using sophisticated electrophysiology. Monosymptomatic rest tremor has recently been shown to be associated with decreased fluorodopa uptake on the positron emission tomography scan suggesting its relationship to Parkinson disease.. Significant advances have been made in the understanding of the pathophysiology, genetics and therapy of tremor disorders during the last 12 months. This review will consider Parkinson disease, essential tremor and other tremors and highlight advances in the field.

Topics: Acetates; Amines; Anticonvulsants; Antiparkinson Agents; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Electromyography; Essential Tremor; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Levodopa; Motor Cortex; Muscle, Skeletal; Parkinson Disease; Posture; Primidone; Randomized Controlled Trials as Topic; Severity of Illness Index; Somatosensory Cortex; Topiramate; Tremor

Essential tremor is a common movement disorder that affects between 5 and 10 million persons in the United States. It is characterized primarily by an action and postural tremor most often affecting the arms, but it can also affect other body parts. Essential tremor is a progressive neurologic disorder and can cause substantial disability in some patients. Although there is no cure for essential tremor, pharmacologic and surgical treatments can provide some benefit. Primidone and propranolol are first-line treatments. Other medications with potential efficacy include benzodiazepines, gabapentin, topiramate, and botulinum toxin. Patients with medication-resistant tremor may benefit from thalamotomy or deep brain stimulation of the thalamus. The use of medical and surgical therapies can provide benefit in up to 80% of patients with essential tremor.

Topics: Acetates; Adrenergic beta-Antagonists; Amines; Anti-Dyskinesia Agents; Anticonvulsants; Benzodiazepines; Botulinum Toxins; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Electric Stimulation Therapy; Essential Tremor; Ethanol; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Primidone; Thalamus; Topiramate

Therapeutic efficacy of topiramate in essential tremor (ET) was assessed in comparison with propranolol in two groups which included 24 and 20 patients, respectively, aged from 21 to 83 years (mean age 53 years). Along with clinical examination, a number of scales: Clinical rating scale for tremor, scale of functional disturbances and Visual-analogous scale have been administered. The efficacy of topiramate was comparable to that of propranolol in 83% and 75% cases, respectively. However topiramate has some therapeutic advantages compared to propranolol; it may be prescribed for all clinical forms regardless of sex (its efficacy is higher in women), age and illness duration, both in earlier and later onset, familial and sporadic variants of ET (propranolol is more effective in patients with family history of ET). Moreover, in contrast to propranolol, topiramate may be prescribed to patients with predisposition to arterial hypertension and bradicardia, bronchial spasms of diabetes mellitus and heart rhythm disturbances.

Topics: Adult; Aged; Aged, 80 and over; Anticonvulsants; Essential Tremor; Female; Fructose; Humans; Male; Middle Aged; Propranolol; Severity of Illness Index; Topiramate

The purpose of this study was to evaluate interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) in essential tremor (ET). Proper treatment of ET is contingent upon correct assessment of the severity, loss of function, and disability related to tremor. Videotape recordings of 17 subjects with ET evaluated with the TRS were produced and sent to 59 raters. Once the raters returned the videotape and completed the score sheet, they were mailed a second tape with the same recordings presented in a different order. In the interrater reliability evaluation, modified Kappa statistics for seven tremor type composites ranged from 0.10 to 0.65 in the first videotape and 0.17 to 0.62 in the second videotape. Interrater reliabilities were greater for Part A items (magnitude of tremor in different body parts) than for Part B items (tremor in writing and drawings) of the TRS. The average Spearman correlation was 0.87, indicating very good consistency between the two videotapes, but correlations for Part A were somewhat better than for Part B. It is best when the same rater performs repeated measures of tremor on a patient, particularly when judging tremor in handwriting and drawings. Training of raters on use of the TRS would help standardize judgement.

Topics: Arm; Essential Tremor; Fructose; Functional Laterality; Handwriting; Humans; Leg; Neuroprotective Agents; Observer Variation; Posture; Reproducibility of Results; Topiramate; Videotape Recording

Essential tremor is most prevalent and most disabling in older patients. Additional therapies are required for patients with an inadequate response or intolerable side effects. In small trials, topiramate appeared to be beneficial in essential tremor.. In this multicenter, double-blind, placebo-controlled, parallel-design trial, patients with moderate to severe essential tremor of the upper limbs were randomized to 24 weeks of treatment with placebo or topiramate (target dose, 400 mg/day) as monotherapy or as an adjunct to one antitremor medication. The primary efficacy variable was the final visit tremor score based on the Fahn-Tolosa-Marin Tremor Rating Scale (TRS).. The intent-to-treat population was 208 patients (topiramate, 108; placebo, 100). The final visit score (last observation carried forward) was lower in the topiramate group than with placebo (p < 0.001). Mean percentage improvement in overall TRS scores was 29% with topiramate at a mean final dose of 292 mg/day and 16% with placebo (p < 0.001). Topiramate was associated with greater improvement in function and disability (p = 0.001). A between-group difference (p < 0.001) was observed at the first on-treatment visit at 4 weeks when the target topiramate dose was 100 mg/day (mean achieved dose, 62 +/- 9 mg/day). The most common treatment-limiting adverse events in topiramate-treated patients were paresthesia (5%), nausea (3%), concentration/attention difficulty (3%), and somnolence (3%). Adverse events were treatment limiting in 31.9% of topiramate patients and 9.5% of placebo patients.. Topiramate was effective in the treatment of moderate to severe essential tremor. Tremor reduction was accompanied by functional improvements, such as in motor tasks, writing, and speaking.

Topics: Adult; Aged; Double-Blind Method; Essential Tremor; Fructose; Functional Laterality; Humans; Middle Aged; Neuroprotective Agents; Placebos; Posture; Topiramate; Treatment Outcome

The safety and efficacy of topiramate (400 mg/d or maximum tolerated dose) as monotherapy or adjunctive treatment of essential tremor were investigated in a placebo-controlled, crossover study (n = 24). Topiramate resulted in significantly greater reductions from baseline based on normalized scores for a clinical rating of tremor location/severity, specific motor tasks/functional disabilities, and tremor-resultant functional disabilities. Most common adverse events were appetite suppression/weight loss and paresthesias.

Topics: Adult; Aged; Anticonvulsants; Cross-Over Studies; Double-Blind Method; Essential Tremor; Female; Fructose; Humans; Male; Middle Aged; Topiramate; Treatment Outcome

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Anticonvulsants; Essential Tremor; Female; Fructose; Humans; Male; Middle Aged; Topiramate

Although first line therapies for essential tremor have been identified from small clinical trials, responses are variable. We conducted a survey of tremor management in a large sample of ET cases.. The Movement Disorders Clinical Case Registry within a US Veterans Health Administration medical center was used to identify 1468 patients with ET.. Of 1468 charts reviewed, 1074 (73.19%) met criteria for ET with characterization of temporal course and treatment; 291/1074 subjects (27.1%) did not receive any treatment. Almost half (500/1074; 46.6%) of the patients received monotherapy, 196/1074 (18.2%) two, 66/1074 (6.1%) three, and 21/1074 (2.0%) four or more medications. Of all prescriptions, primidone was the most used (546/1172; 46.6%), followed by propranolol (419; 35.8%), topiramate (122; 10.4%) and gabapentin (35; 3.0%). Medication response was available for a total of 1030 prescriptions, of which 138 (13.4%) were discontinued due to side effects; 180 (17.5%) prescriptions were ineffective. Furthermore, 52/1074 patients (4.8%) were treated with botulinum toxin injections and 41/1074 (3.8%) underwent deep brain stimulation surgery.. Our data suggest that more widespread recognition of limitations underlying conventional approaches, as well as increased referrals for nonpharmacological therapies, may be necessary to achieve improved outcomes in ET populations.

Topics: Essential Tremor; Humans; Primidone; Propranolol; Retrospective Studies; Topiramate

Heatstroke is a life-threatening condition defined by failure of heat load dissipation, resulting in a core temperature higher than 40 °C (104 °F) associated with neurological dysfunction. Topiramate may cause anhidrosis, potentially resulting in heatstroke, as reported especially in children.. A 57-year-old Caucasian man was admitted to the emergency room in a febrile comatose state. After a complete workup ruling out the usual etiologies of such a condition, we assumed the hypothesis of a heatstroke caused by topiramate, recently prescribed for essential tremor.. Topiramate-related heatstroke has been described in children but must be recognized in adults as well. Outcomes may range from total clinical recovery to persistent neurological dysfunction or death. The prescription of topiramate and the follow-up of adult patients under this medication should include an evaluation of hypohidrosis, especially in contexts of high temperature.

Topics: Anticonvulsants; Essential Tremor; Fructose; Heat Stroke; Humans; Male; Middle Aged; Topiramate

Topics: Aged; Anticonvulsants; Drug Therapy, Combination; Essential Tremor; Fructose; Humans; Lorazepam; Male; Severity of Illness Index; Topiramate