Evidence-based guideline update: Treatment of essential tremor

Zesiewicz, Theresa A.; Elble, Rodger J.; Louis, Elan D.; Gronseth, Gary S.; Ondo, William G.; Dewey, Richard B.; Okun, Michael S.; Sullivan, Kelly L.; Weiner, William J.

doi:10.1212/wnl.0b013e318236f0fd

Cited by 297 publications

(213 citation statements)

References 22 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.…”

mentioning

confidence: 88%

“…However, only 2 drugs-propranolol and primidone-appear to have sufficient class I support for a level A recommendation of efficacy, and these are thus often recommended as drugs of "first choice" [8,9,32]. However, more recent analyses suggest that topiramate may be better established than previously recognized.…”

Section: Treatment Of Limb Tremor In Etmentioning

confidence: 99%

“…Vim, the zona incerta, and the radiation praelemniscalis are all in close proximity and are probably the best targets for ET [9]. Several articles have summarized the long-term results [8,9]; however, there are no double-blind, placebo-controlled trials, also because true blinding is difficult.…”

Section: Botulinum Toxin For Et Limb Tremormentioning

confidence: 99%

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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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mentioning

confidence: 88%

Section: Treatment Of Limb Tremor In Etmentioning

confidence: 99%

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The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…6,7 According to the American Academy of Neurology guidelines, treatment with β-blockers (e.g., propranolol) or anticonvulsants (e.g., primadone) should be started when the tremor results in functional disability or social embarrassment (Appendix 3 available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj .120496/-/DC1). 8,9 Although these guidelines are based on studies involving adults, a paucity of studies involving children necessitates that current practice extrapolate this evidence to tremor in children.…”

Section: Essential Tremormentioning

confidence: 99%

Two children with tremor

Liu

Pringsheim

Thompson

2014

CMAJ

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A right-handed 14-year-old boy was referred to a neurologist for an outpatient evaluation of tremor. The boy was previously healthy and not taking any medications. Developmental milestones were achieved within the appropriate norms. There was a family history of tremor in the boy's mother and maternal uncle. The mother reported that her tremor lessened following the consumption of alcohol. The parents first noticed the tremor in their son when he was about six years old. The tremor occurred mainly during voluntary activity, such as writing, eating soup with a spoon, drinking from a cup and using his hands for small skilled movements. The tremor affected both arms and was worse on the right side. His head, voice and legs were unaffected. The tremor was worse when he was physically tired (e.g., after heavy lifting) or nervous (e.g., public speaking). Over the years, the tremor has worsened slightly and has become a source of embarrassment to him.On examination, the patient showed no distress and had normal vital signs; he was alert, behaved appropriately and had age-appropriate speech and language. Results of a cranial nerve examination were normal. A motor system examination showed normal bulk and tone. Strength in the upper and lower limbs was graded as 5 out of 5 in a manual muscle test. Results of sensory and gait examinations were normal. He was able to walk without difficulty using a tandem gait.

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“…There are several symptomatic therapies for the treatment of ET including pharmacologic agents and surgical procedures, which are considered effective (10). However, possible therapeutic approaches to the treatment of balance and gait impairment in ET are not known.…”

Section: Introductionmentioning

confidence: 99%

The Effects of a Postural Balance Training Program on Balance, Gait and Health-Related Quality of Life in Patients with Essential Tremor

Kara¹,

Kahraman²,

Tomruk³

et al. 2018

tnd

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Objective: Although the effectiveness of postural balance training on balance and gait impairment has been proven as an effective treatment approach in several patient and healthy populations, its effectiveness in patients with essential tremor (ET) is yet unknown. The aim was to examine the effects of postural balance training program on balance and gait performance, and health-related quality of life in patients with ET. Materials and Methods: This uncontrolled clinical study included patients with ET. The outcome measures were the Postural Stability Test, Limits of Stability Test, Fall Risk Test, Activities-Specific Balance Confidence scale, Dynamic Gait Index, and Short Form-36. The assessments were performed before and after the training program. The participants underwent an 8-week balance training designed to improve their ability to integrate multisensory inputs and postural control using a computerized balance assessment and training device. Results: In total, 24 patients with ET participated in the study. The compliance rate was 87.5%. There were significant improvements in all outcome measures of balance and gait performance, balance confidence, fall risk, and health-related quality of life (except the mental component, p>0.05) between baseline and 8 weeks (p<0.05). Conclusion: Our results suggest that the balance training program is a feasible method that may have positive effects on balance performance and confidence, gait performance, and health-related quality of life in patients with ET. Keywords: Balance training, essential tremor, gait, quality of life Amaç: Postürel denge eğitiminin çeşitli hastalıklarda ve sağlıklılarda denge ve yürüme bozukluğu için etkin bir tedavi yaklaşımı olarak kanıtlanmış olmasına rağmen esansiyel tremorlu (ET) hastalarda etkinliği henüz bilinmemektedir. Bu çalışmanın amacı, postürel denge eğitim programının ET'li hastalardaki denge, yürüme performansı ve sağlıkla ilgili yaşam kalitesi üzerine etkilerini incelemek idi. Gereç ve Yöntem: Bu kontrolsüz klinik çalışmaya ET'li hastalar dahil edildi. Sonuç ölçümleri Postürel Stabilite Testi, Stabilite Testi Sınırları, Güz Risk Testi, Aktivitelere Özgü Denge Güven Ölçeği, Dinamik Yürüme İndeksi ve Kısa Form-36'dan oluşmaktaydı. Değerlendirmeler, eğitim programından önce ve sonra gerçekleştirildi. Katılımcılar, bilgisayar tabanlı denge değerlendirme ve eğitim cihazı ile çoklu duyusal girdileri ve postürel kontrolleri bütünleştirme yeteneklerini geliştirmek için tasarlanmış 8 haftalık bir denge eğitimine tabi tutuldu. Bulgular: Çalışmaya toplam 24 ET'li hasta katıldı. Programı tamamlama oranı %87,5 idi. Sekiz haftanın sonunda denge ve yürüme performansı, denge güveni, düşme riski ve sağlıkla ilgili yaşam kalitesini içeren (zihinsel bileşen hariç, p>0,05) tüm sonuç ölçümlerinde anlamlı iyileşmeler tespit edildi (p<0,05). Sonuç: Bu çalışmanın bulguları, denge eğitim programının ET'li hastalardaki denge performansı ve güvenini, yürüme performansını ve sağlıkla ilgili yaşam kalitesini olumlu etkileyebilecek uygun bir yöntem olduğun...

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Evidence-based guideline update: Treatment of essential tremor

Abstract: Background: This evidence-based guideline is an update of the

Cited by 297 publications

References 22 publications

The Treatment of Tremor

The Treatment of Tremor

Two children with tremor

The Effects of a Postural Balance Training Program on Balance, Gait and Health-Related Quality of Life in Patients with Essential Tremor

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