A STUDY OF EFFICACY OF TREATMENT FOR ESSENTIAL TREMOR USING TREMOROGRAPHY

Cover Page

Cite item

Abstract

Background: Essential tremor is one of the most prevalent extrapyramidal disorders, while treatment efficacy in such patients remains low. Clinical polymorphism of essential tremor requires a  differentiated treatment approach, that should be implemented with consideration of objective tremor parameters. Aim: To study efficacy of treatment of essential tremor based on tremorography. Materials and methods: We followed up 85  patients with essential tremor (mean age, 69.05±1.2  years) who were treated with anticonvulsants as monotherapy (primidone or topiramate), or with combination treatment with non-selective beta-blockers (propranolol), anxiolytics (hydroxizine, etifoxine) and aminophenylbutyric acid. During the treatment, we assessed changes in functional status by Fahn-Tolosa-Marin Tremor Severity Scale and by tremorography. Results: Under treatment with primidone, there was a decrease in global tremor assessment of postural tremor (p=0.036) and of action tremor (p=0.001). During treatment with topiramate, there was a decrease in global tremor assessment in all tests performed (p<0.0002). Non-specific treatment (anxiolytics) exerted a positive effect on the functional state of patients with essential tremor. Conclusion: Tremor amplitude and duration are the objective parameters that define its severity. The treatment guidelines for essential tremor in the elderly patients have been developed.

About the authors

D. V. Zakharov

St. Petersburg Psychoneurological Research Institute

Author for correspondence.
Email: zaharov_dv@mail.ru

MD, PhD, Neurologist, Head of Department of Rehabilitation of Psychosomatic Patients

3 Bekhtereva ul., Saint Petersburg, 192019

Tel.: +7 (812) 670 02 36

Russian Federation

Yu. V. Yarygina

St. Petersburg Psychoneurological Research Institute

Email: fake@neicon.ru

MD, Neurologist, Postgraduate Student

3 Bekhtereva ul., Saint Petersburg, 192019

Russian Federation

V. A. Mikhaylov

St. Petersburg Psychoneurological Research Institute

Email: fake@neicon.ru

MD, PhD, Chief Research Fellow, Deputy Director, Chairperson of Department of Rehabilitation of Psychosomatic Patients

3 Bekhtereva ul., Saint Petersburg, 192019

Russian Federation

V. A. Bogacheva

St. Petersburg Psychoneurological Research Institute

Email: fake@neicon.ru

MD, Neurologist, Postgraduate Student

3 Bekhtereva ul., Saint Petersburg, 192019

Russian Federation

L. A. Khublarova

St. Petersburg Psychoneurological Research Institute

Email: fake@neicon.ru

MD, Neurologist, Department of Rehabilitation of Psychosomatic Patients

3 Bekhtereva ul., Saint Petersburg, 192019

Russian Federation

References

  1. Иванова-Смоленская ИА. Дрожательные гиперкинезы. В: Шток ВН, Иванова-Смоленская ИА, Левин ОС, ред. Экстрапирамидные расстройства: руководство по диагностике и лечению. М.: МЕДпресс-информ; 2002. с. 264–81.
  2. Louis ED, Ottman R. How familial is familial tremor? The genetic epidemiology of essential tremor. Neurology. 1996;46(5):1200–5.
  3. Deng H, Le W, Jankovic J. Genetics of essential tremor. Brain. 2007;130(Pt 6):1456–64. doi: http://dx.doi.org/10.1093/brain/awm018 1456-1464.
  4. Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord. 2010;25(5):534–41. doi: 10.1002/mds.22838.
  5. Иллариошкин СН, Иванова-Смоленская ИА. Дрожательные гиперкинезы: руководство для врачей. М.: Атмосфера; 2011. 360 с.
  6. Zesiewicz TA, Elble R, Louis ED, Hauser RA, Sullivan KL, Dewey RB Jr, Ondo WG, Gronseth GS, Weiner WJ; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2005;64(12):2008–20. doi: http://dx.doi. org/10.1212/01.WNL.0000163769.28552.CD.
  7. Zesiewicz TA, Elble RJ, Louis ED, Gronseth GS, Ondo WG, Dewey RB Jr, Okun MS, Sullivan KL, Weiner WJ. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology. Neurology. 2011;77(19):1752–5. doi: 10.1212/ WNL.0b013e318236f0fd.
  8. Zesiewicz TA, Chari A, Jahan I, Miller AM, Sullivan KL. Overview of essential tremor. Neuropsychiatr Dis Treat. 2010;6:401–8. doi: 10.2147/NDT.S4795.
  9. Koller WC, Royse VL. Efficacy of primidone in essential tremor. Neurology. 1986;36(1):121–4.
  10. Sasso E, Perucca E, Fava R, Calzetti S. Primidone in the long-term treatment of essential tremor: a prospective study with computerized quantitative analysis. Clin Neuropharmacol. 1990;13(1):67–76. 11. Findley LJ, Cleeves L, Calzetti S. Primidone in essential tremor of the hands and head: a double blind controlled clinical study. J Neurol Neurosurg Psychiatry. 1985;48(9): 911–5.
  11. O'Suilleabhain P, Dewey RB Jr. Randomized trial comparing primidone initiation schedules for treating essential tremor. Mov Disord. 2002;17(2):382–6.
  12. Gorman WP, Cooper R, Pocock P, Campbell MJ. A comparison of primidone, propranolol, and placebo in essential tremor, using quantitative analysis. J Neurol Neurosurg Psychiatry. 1986;49(1):64–8.
  13. Chang KH, Wang SH, Chi CC. Efficacy and Safety of Topiramate for Essential Tremor: A Meta￾Analysis of Randomized Controlled Trials. Medicine (Baltimore). 2015;94(43):e1809. doi: 10.1097/MD.0000000000001809.
  14. Залялова ЗА, Латыпова ГР. Топирамат в лечении эссенциального тремора. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;108(11):39–42.
  15. Ondo WG, Jankovic J, Connor GS, Pahwa R, Elble R, Stacy MA, Koller WC, Schwarzman L, Wu SC, Hulihan JF; Topiramate Essential Tremor Study Investigators. Topiramate in essential tremor: a double-blind, placebo-controlled trial. Neurology. 2006;66(5):672–7.
  16. Shank RP, Gardocki JF, Streeter AJ, Maryanoff BE. An overview of the preclinical aspects of topiramate: pharmacology, pharmacokinetics, and mechanism of action. Epilepsia. 2000;41 Suppl 1:S3–9. doi: 10.1111/ j.1528-1157.2000.tb01538.x.
  17. Gálvez-Jiménez N, Hargreave M. Topiramate and essential tremor. Ann Neurol. 2000;47(6):837–8. doi: 10.1002/1531-8249(200006)47:63.0.CO;2-2.
  18. Connor GS. A double-blind placebo-controlled trial of topiramate treatment for essential tremor. Neurology. 2002;59(1):132–4.
  19. Connor GS, Edwards K, Tarsy D. Topiramate in essential tremor: findings from doubleblind, placebo-controlled, crossover trials. Clin Neuropharmacol. 2008;31(2):97–103. doi: 10.1097/WNF.0b013e3180d09969.
  20. Findley LJ, Koller WC, editors. Handbook of tremor disorders. N.Y.: Marcel Dekker; 1995. 600 p.
  21. Fahn S, Tolosa E, Marin C. Clinical rating scale for tremor. In: Jankovic J, Tolosa E, editors. Parkinson's disease and movement disorders. Baltimore – Munich: Urban & Schwarzenberg; 1988. p. 225–34.
  22. Stacy MA, Elble RJ, Ondo WG, Wu SC, Hulihan J; TRS study group. Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor. Mov Disord. 2007;22(6):833–8. doi: 10.1002/ mds.21412.
  23. Hedera P, Cibulčík F, Davis TL. Pharmacotherapy of essential tremor. J Cent Nerv Syst Dis. 2013;5:43–55. doi: 10.4137/JCNSD.S6561.
  24. Прокопенко СВ, Шанина ЕГ. Диагностика состояний вегетативной дисфункции с использованием метода компьютерной пальцевой треморографии. Анналы клинической и экспериментальной неврологии. 2011;5(2):14–7.
  25. Serrano-Dueñas M. Use of primidone in low doses (250 mg/day) versus high doses (750 mg/day) in the management of essential tremor. Double-blind comparative study with one-year follow-up. Parkinsonism Relat Disord. 2003;10(1):29–33. doi: 10.1016/S1353- 8020(03)00070-1.
  26. Шубина ЮВ, Захаров ДВ, Михайлов ВА, Богачева ВА. Психосоциальные аспекты и показатели качества жизни больных эссенциальным тремором. Психология и педагогика в XXI веке. Очерки научного развития. Ежемесячный научный журнал. Новосибирск. 2015;10(18):64–9.
  27. Zesiewicz TA, Ward CL, Hauser RA, Sanchez-Ramos J, Staffetti JF, Sullivan KL. A doubleblind placebo-controlled trial of zonisamide (zonegran) in the treatment of essential tremor. Mov Disord. 2007;22(2):279–82. doi: 10.1002/mds.21282.
  28. Sasso E, Perucca E, Calzetti S. Double-blind comparison of primidone and phenobarbital in essential tremor. Neurology. 1988;38(5): 808–10.
  29. Findley LJ, Calzetti S. Double-blind controlled study of primidone in essential tremor: preliminary results. Br Med J (Clin Res Ed). 1982;285(6342):608.
  30. Gironell A, Kulisevsky J, Barbanoj M, López-Villegas D, Hernández G, Pascual-Sedano B. A randomized placebo-controlled comparative trial of gabapentin and propranolol in essential tremor. Arch Neurol. 1999;56(4):475–80. doi: 10.1001/archneur.56.4.475.

Copyright (c) 2016 Zakharov D.V., Yarygina Y.V., Mikhaylov V.A., Bogacheva V.A., Khublarova L.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies