NEW YORK (Reuters Health) – The American Academy of Neurology has updated its guideline on treating essential tremor, still recommending the use of propranolol and the primidone but no longer endorsing levetiracetam or flunarizine.

The guideline, published in the November 8th issue of Neurology and released online October 19, updates the 2005 AAN practice parameter on the treatment of essential tremor. Changes from the previous guidelines are mainly withdrawals of recommendations.

For example, the authors say levetiracetam and 3,4-diaminopyridine should no longer be considered for use as they probably do not reduce limb tremor; and flunarizine is even less likely to be effective.

As for the use of pregabalin, zonisamide, or clozapine, the panel concludes that there is insufficient evidence to support or refute these agents.

The positive treatment recommendations are unchanged from the previous guideline. That is, propranolol and primidone are established as effective, while alprazolam, atenolol, gabapentin, sotalol, and topiramate are probably effective. Nadolol, nimodipine, clonazepam, and botulinum toxin A are deemed possibly effective.

“Not all people with essential tremor benefit from these drugs,” lead guideline author Dr. Theresa A. Zesiewicz, with the University of South Florida in Tampa, noted in a journal press release. “For people who are not benefitting from these drugs, it’s important they work with their neurologist to explore other types of treatments.”

The guideline also points out that there has been no new evidence to change the previous conclusion that deep brain stimulation and thalamotomy are possibly effective.

The authors conclude with recommendations for future research, saying “Controlled clinical trials of additional medications are needed using standardized outcome measures of tremor, including disability scales and cost-benefit analyses.”

Reference:

Neurology 2011;77.