Primidone in essential tremor of the hands and head: a double blind controlled clinical study.

doi:10.1136/jnnp.48.9.911

Paper

Primidone in essential tremor of the hands and head: a double blind controlled clinical study.

Published Sep 1, 1985 · L. Findley, L. Cleeves, Stephano CALZETTIt

Journal of Neurology, Neurosurgery & Psychiatry

Q1 SJR score

110

Citations

3

Influential Citations

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Abstract

Uncontrolled clinical studies have suggested that primidone may be effective in reducing essential tremor thus providing a valuable alternative to beta-adrenoreceptor antagonists which are currently the drugs of first choice. A double blind, placebo controlled trial of primidone in essential tremor of the hands and head was carried out using both clinical and objective methods of assessment. Primidone was significantly superior to placebo in reducing the magnitude of hand tremor, its efficacy being comparable to that of propranolol. In two patients tremor was reduced to non-symptomatic levels, an effect rarely seen with propranolol. No consistent attenuation of head tremor was found. There was no correlation between serum primidone or derived phenobarbitone concentrations and the reduction of hand tremor. An acute toxic reaction to an initial small dose (62.5 mg) of primidone was seen in six of 22 patients.

RCT

Highly Cited

Study Snapshot

Primidone effectively reduces hand tremor, offering an alternative to beta-adrenoreceptor antagonists, but does not consistently attenuate head tremor.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Paper

Primidone in essential tremor of the hands and head: a double blind controlled clinical study.

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References

Beta-adrenoreceptor mechanisms in essential tremor: a comparative single dose study of the effect of a non-selective and a beta-2 selective adrenoreceptor antagonist.

Beta-adrenoreceptor antagonists, such as LI 32-468 and propranolol, effectively reduce tremor magnitude in essential tremor patients, with their beneficial effect mediated through peripheral beta-2 receptor mechanisms.

Propranolol therapy for essential tremor of the head

Propranolol effectively treats essential tremor of the head, paralleling its effectiveness on hand tremor.

The response of essential tremor to propranolol: evaluation of clinical variables governing its efficacy on prolonged administration.

Propranolol effectively reduces essential tremor amplitude by 45% at 240 mg daily, but patients with small tremor amplitude should not be treated unless their tremor becomes severely aggravated under excessive adrenergic discharge.

Phenobarbital and propranolol in essential tremor

Phenobarbital may be a valuable alternative to propranolol in treating essential tremor, but manual skill improvement was not significantly improved by any treatment.

Double-blind controlled study of primidone in essential tremor: preliminary results.

Lactation may induce convulsions in patients with epilepsy, and routine biochemical screening is advised in these cases.

Citations

Mechanisms of tremor-modulating effects of primidone and propranolol in essential tremor.

Primidone reduces hand tremor by blocking voltage-gated sodium channels and modulating GABA-A and GABA-B intracortical circuits, while propranolol reduces tremor by modulating GABA outflow through noradrenergic modulation.

Management of anti-seizure medications in lactating women with epilepsy

Women with epilepsy can safely breastfeed while taking anti-seizure medications, but may have concerns about their milk's impact on the baby's growth and development.

Prospective, longitudinal analysis of medication use in a cohort of elderly essential tremor cases

Elderly essential tremor patients experience significant medication changes, highlighting the need for improved medication management.

The Pharmacotherapeutic Landscape for Essential Tremor: Quantifying the Level of Unmet Need From a Patient and Epidemiologic Perspective.

The unmet need for essential tremor treatment is unclear, as the majority of patients with milder tremors do not seek medical care, and factors like age, sex, education, health literacy, and locale influence receptivity to treatment.

Update on Antiseizure Medications 2022

Newer antiseizure medications show equal efficacy and tolerability to older ones, making them suitable for first-line therapy in focal epilepsy.

Primidone Intolerance in Essential tremor: Is it More than Just Age?

Primidone intolerance in essential tremor patients may be due to factors such as older age, cross-tolerance with epilepsy, and neurobiological abnormalities.

Focused Ultrasound Thalamotomy for the Treatment of Essential Tremor: A 2-Year Outcome Study of Chinese People

MRgFUS thalamotomy effectively reduces essential tremor severity in Chinese patients with drug-refractory essential tremor, with few adverse events and safe treatment despite low skull density ratios.