TY - JOUR
T1 - Treatment of essential tremor: A systematic review of evidence and recommendations from the Italian Movement Disorders Association
AU - Zappia, Mario
AU - Albanese, Alberto
AU - Bruno, Elisa
AU - Colosimo, Carlo
AU - Filippini, Graziella
AU - Martinelli, Paolo
AU - Nicoletti, Alessandra
AU - Quattrocchi, Graziella
PY - 2013
Y1 - 2013
N2 - Essential tremor (ET) is one of the most common movement disorders of adults, characterized by postural and kinetic tremor. It often causes embarrassment and more rarely serious disability, requiring treatment. To assess the current state of knowledge on ET therapy and produce recommendations based on the analysis of evidence the authors reviewed the literature regarding pharmacologic and surgical therapies, providing a quality assessment of the studies and the strength of recommendations for each treatment. A committee of experts selected clinical-based questions to guide the search. A systematic literature review was performed to identify all the studies conducted on patients with ET published until September 2010. Articles were classified according to GRADE evidence profile, a system for grading the quality of evidence and the strength of recommendation based on the quality of the studies. The quality of evidence was often rated as "low" or "very low" for the studies analyzed. Propranolol, long-acting propranolol, primidone, and topiramate are recommended as first-line therapy, with restrictions for their side effects. Arotinolol, sotalol, ICI 118.551 and LI 32.468 (experimental drugs), zonisamide, gabapentin, alprazolam, clozapine, and olanzapine are recommended as a second-line treatment. Botulinum toxin type A and thalamic deep-brain stimulation are recommended for refractory ET. The results highlight the need of well-designed direct comparison trials aimed at evaluating relative effectiveness and safety of the drugs currently used in clinical practice. Furthermore, additional controlled clinical trials are required to define other possible treatment strategies for ameliorating the management of ET. © 2012 Springer-Verlag.
AB - Essential tremor (ET) is one of the most common movement disorders of adults, characterized by postural and kinetic tremor. It often causes embarrassment and more rarely serious disability, requiring treatment. To assess the current state of knowledge on ET therapy and produce recommendations based on the analysis of evidence the authors reviewed the literature regarding pharmacologic and surgical therapies, providing a quality assessment of the studies and the strength of recommendations for each treatment. A committee of experts selected clinical-based questions to guide the search. A systematic literature review was performed to identify all the studies conducted on patients with ET published until September 2010. Articles were classified according to GRADE evidence profile, a system for grading the quality of evidence and the strength of recommendation based on the quality of the studies. The quality of evidence was often rated as "low" or "very low" for the studies analyzed. Propranolol, long-acting propranolol, primidone, and topiramate are recommended as first-line therapy, with restrictions for their side effects. Arotinolol, sotalol, ICI 118.551 and LI 32.468 (experimental drugs), zonisamide, gabapentin, alprazolam, clozapine, and olanzapine are recommended as a second-line treatment. Botulinum toxin type A and thalamic deep-brain stimulation are recommended for refractory ET. The results highlight the need of well-designed direct comparison trials aimed at evaluating relative effectiveness and safety of the drugs currently used in clinical practice. Furthermore, additional controlled clinical trials are required to define other possible treatment strategies for ameliorating the management of ET. © 2012 Springer-Verlag.
KW - Animals
KW - Clinical Trials as Topic
KW - Clozapine
KW - Deep Brain Stimulation
KW - Essential Tremor
KW - Essential tremor
KW - Humans
KW - Italy
KW - Movement Disorders
KW - Practice Guidelines as Topic
KW - Propranolol
KW - Recommendations
KW - Systematic review
KW - Treatment
KW - Treatment Outcome
KW - Animals
KW - Clinical Trials as Topic
KW - Clozapine
KW - Deep Brain Stimulation
KW - Essential Tremor
KW - Essential tremor
KW - Humans
KW - Italy
KW - Movement Disorders
KW - Practice Guidelines as Topic
KW - Propranolol
KW - Recommendations
KW - Systematic review
KW - Treatment
KW - Treatment Outcome
UR - http://hdl.handle.net/10807/170540
U2 - 10.1007/s00415-012-6628-x
DO - 10.1007/s00415-012-6628-x
M3 - Article
SN - 0340-5354
VL - 260
SP - 714
EP - 740
JO - Journal of Neurology
JF - Journal of Neurology
ER -