Successful Treatment of Primary Orthostatic Tremor Using Perampanel

Abstract

Background: Primary orthostatic tremor (POT) remains a therapeutic conundrum. Various medication classes have been tried, yielding modest results at best. Case Report: A 62-year-old female with a 13-year history of POT, refractory to clonazepam up to 20 mg/day, was treated with perampanel 1-2 mg/day. She reported 90% subjective symptomatic improvement. Discussion: This case highlights the potential for use of perampanel, a novel AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist for the treatment of POT. There has been one prior report citing its use for POT with complete resolution of symptoms. We encourage further studies to highlight its efficacy for POT.

Non‐Persistence of Tremorolytic Effect of Perampanel in Essential Tremor: Real‐World Experience with 50 Patients

“…In humans, several case reports have demonstrated perampanel to have a tremorolytic effect on POT 4–6 . Two main studies have been conducted on the use of perampanel for ET.…”

“…Drug treatment for essential tremor (ET) is often unsatisfactory and more treatment options are clearly needed 1 . Perampanel, licensed and marketed as an antiepileptic drug that blocks glutamate‐mediated postsynaptic excitation, has shown efficacy in pilot studies of ET and in primary orthostatic tremor (POT) 2–6 . However, in a recent study evaluating perampanel for POT, it was observed that, although therapeutic efficacy was very high in the early weeks of treatment, the benefit failed to persist in ~50% of patients by ~3 months of treatment 6 .…”

Medications used to treat tremors

“…Clonazepam can result in excessive sedation and depression. A few clinical trials of gabapentin have shown it to be useful in OT with a reduction in amplitude and postural sway from 71 to 79% [73][74][75] Perampanel: There have been three case reports of perampanel resulting in marked improvement in symptoms of OT [76][77][78]. Two reports using lower doses of perampanel did not find any electrophysiological evidence of improvement [76,77] and one report using 4 mg perampanel found electrophysiological evidence of improvement [78]…”

Primary Orthostatic Tremor: Experience of Perampanel Use in 20 Patients

“…Recently, it has been reported complete resolution of POT symptoms in two patients using low doses of perampanel, an antiepileptic drug that blocks glutamate-mediated postsynaptic excitation. 4,5 In the current study, we describe our experience of using perampanel in 20 patients with POT. Although ours was not a controlled trial, our findings and conclusions may be of interest due to the low prevalence of this disorder.…”