THE EFFECTIVENESS OF TREATMENTS FOR ESSENTIAL TREMOR

摘要

BACKGROUNDndash; Essential tremor is one of the most common movement disorders encountered in clinical practice. Patients with this disorder have action tremors of the upper limbs and, in some cases, of the head, voice, jaw, face, tongue, legs, and trunk. Essential tremor can be inherited as an autosomal dominant characteristic or can occur sporadically. It may cause significant disability and handicap. The efficacy of treatment for essential tremor is reviewed.REVIEW SUMMARYndash; The neurologist must have a therapeutic strategy for patients with essential tremor because the condition is frequently encountered in clinical practice. Furthermore, the data supporting that strategy and, thus, choice of treatment need to be carefully evaluated so that practice is evidence-based. The results of previous clinical trials are presented in this review, along with a conceptual framework for assessing their clinical relevance.CONCLUSIONndash; Although propranolol and primidone are established treatments for essential tremor, the evidence for their efficacy is largely obtained from accelerometric studies. The marked improvement in tremor detected in the accelerometric studies of these drugs does not necessarily translate to an improvement in the disability and social handicap experienced by patients. In fact, there presently is scant evidence to suggest that these drugs have much influence on patients' lives, and further research aimed at establishing the influence of medication on tremor-induced disability, handicap, and quality of life is clearly required. The alternative to medication is stereotactic surgery, which can without doubt influence disability but has potentially serious consequences. Those disabled tremulous patients who respond poorly to drugs are thus faced with the dilemma of whether to take the risks involved with surgery or to continue taking medications, which also have significant side effect profiles. Nevertheless, many essential tremor patients seem to cope admirably with the help of either primidone, propranalol, or both.