Successful treatment of two cases of intention tremor with clonazepam

Trelles, Luis; Trelles, J. O.; Castro, Conrado; Altamirano, Juan; Benzaquen, Max

doi:10.1002/ana.410160516

Cited by 29 publications

(7 citation statements)

References 1 publication

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“…Isoniazid (isonicotinic acid hydrazide) (INH) (900-1200 mg/d) and tetrahydrocannabinol, both putative gamma-aminobutyric acid (GABA) agonists, have been reported in a small cohort of MS patients to decrease the severity of intention and postural cerebellar tremor (Sabraet al, 1982;Franciset al, 1986;Clifford, 1983;Hallettetal., 1985;Trelles et al, 1984), but the findings with respect to the effects of INH remain controversial (Bozek et al, 1984;Scheinberg & Giesser, 1984;Koller, 1984 b). There are also reports that administration of the precursors of serotonin (5-HT), L-tryptophan and 5-hydroxytryptophan (5-HTP) and clonazepam, a 5-HT agonist (Van Woert & Chung Hwang, 1981), improve cerebellar symptoms including cerebellar tremor in MS (Rascol et al, 1981;Trouillas et al, 1988;Trelles et al, 1984;Trouillas et al, 1981;Sandyk et al, 1989). In severe cases of MS with incapacitating intention and/or postural tremor, stereotactic thalamotomy may be beneficial (Cooper, 1967;Brice & McLellan, 1980), but this procedure has not gained widespread acceptance (Koller,I984 a;b).…”

Section: R Sandyk and L C Dannmentioning

confidence: 96%

Weak electromagnetic fields attenuate tremor in multiple sclerosis

Sandyk

Dann

1994

International Journal of Neuroscience

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It has been estimated that about 75% of patients diagnosed with multiple sclerosis (MS) have tremor which can be exceedingly disabling. The most common tremor observed in patients with MS is a cerebellar intention tremor ('kinetic tremor') although postural tremor ('static tremor') is also common and often extremely incapacitating. Currently there is no effective medical treatment for the tremor of MS which, in some severe cases, may be abolished by stereotactic thalamotomy. It was reported recently that extracranial application of brief AC pulsed electromagnetic fields (EMFs) in the picotesla (pT) range produced improvement in motor and cognitive functions in patients with MS. The present communication concerns three MS patients with a chronic progressive course of the disease (mean age: 39.3 +/- 8.3 years; mean duration of illness: 11.3 +/- 3.2 years) in whom brief external applications of pulsed EMFs of 7.5 pT intensity reduced intention and postural tremors resulting in significant functional improvement. The report suggests that these extremely low intensity EMFs are beneficial also in the treatment of tremors in MS and that this treatment may serve as an alternative method to stereotactic thalamotomy in the management of tremor in MS. The mechanisms by which EMFs attenuate the tremors of MS are complex and are thought to involve augmentation of GABA and serotonin (5-HT) neurotransmission in the cerebellum and its outflow tracts.

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Section: R Sandyk and L C Dannmentioning

confidence: 96%

Weak electromagnetic fields attenuate tremor in multiple sclerosis

Sandyk

Dann

1994

International Journal of Neuroscience

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“…Clonazepam (3–6 mg/day) may be of some benefit in cerebellar tremor, too [156]. The effect of oxitriptan (5-hydroxytryptophan) on ataxia of the trunk and legs usually occurs only after treatment with 3 × 300 mg/day over about 6 weeks (class III evidence [157]).…”

Section: Ataxia and Tremormentioning

confidence: 99%

Symptomatic Treatment of Multiple Sclerosis

2006

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Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one may be avoided. Many therapeutic techniques as well as different drugs are used for the treatment of MS symptoms, but only a few of them have been investigated, especially in MS patients, and are approved by the national health authorities. Despite an overwhelming number of publications, only a few evidence-based studies exist and consensus reports are very rare, too. Therefore, it seemed necessary to develop a consensus statement on symptomatic treatment of MS comprising existing evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination, of cranial nerve function, of autonomic, cognitive, and psychological functions as well as MS-related pain syndromes and epileptic seizures.

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“…Clonazepam is a long-acting benzodiazepine that has been studied for the treatment of essential tremor; however, only case reports support its use for the treatment of tremor in primary cerebellar ataxias [22,Class IV].…”

Section: Clonazepammentioning

confidence: 99%

Therapeutic Interventions in the Primary Hereditary Ataxias

Revuelta

Wilmot

2010

Curr Treat Options Neurol

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The treatment of hereditary ataxia is primarily supportive. With very few exceptions (eg, ataxia associated with vitamin E deficiency), there are no disease-modifying therapies. Despite the lack of disease-modifying treatments, there can be great value in obtaining an accurate diagnosis of hereditary ataxia subtype. Benefits include determining prognosis, facilitating family counseling, improving research access, and providing some psychological benefit in ending the often frustrating search for an accurate etiology. Hereditary ataxias may have certain clinical features that respond very well to symptomatic medical therapy. Parkinsonism, dystonia, spasticity, urinary urgency, sleep pathology, fatigue, and depression are all common in many of the ataxia subtypes and very often respond to pharmacologic intervention as in other diseases. Much of the clinical interaction between neurologist and ataxia patient should focus on identifying and treating these symptoms. Treatment of the core clinical feature of these diseases-ataxia-is predominantly rehabilitative. The value of good physical therapy far exceeds any potential benefit from medications that a physician might prescribe to improve balance and coordination. Speech and swallowing are often affected. In more severe cases, aspiration risk can be very significant and life-threatening. Routine monitoring of swallowing by speech therapists, often including modified barium swallowing tests, is indicated in most patients. Recently there have been very encouraging advances in clinical ataxia research. Collaborative study groups throughout the world have developed and validated ataxia rating scales and instrumented outcome measures and have begun to rigorously define the natural history of these diseases, thus laying the foundation for well-designed clinical trials. The promise of disease-modifying treatments is closer than ever.

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Successful treatment of two cases of intention tremor with clonazepam

Cited by 29 publications

References 1 publication

Weak electromagnetic fields attenuate tremor in multiple sclerosis

Weak electromagnetic fields attenuate tremor in multiple sclerosis

Symptomatic Treatment of Multiple Sclerosis

Therapeutic Interventions in the Primary Hereditary Ataxias

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