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Evidence summaries

Topiramate for Essential Tremor

Topiramate might possibly have some efficacy in essential tremor, but its' use is limited due to the presence of important adverse events. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 3 studies with a total of 309 subjects. Included patients had a definite upper-limb essential tremor according to criteria proposed by Tremor Investigation Group. Age ranged between 18 and 80 years. The treatment time varied between 2 and 24 weeks. The co-therapy (mainly beta-blockers, benzodiazepine and primidone) was maintained throughout the study period. Compared to placebo, patients treated with topiramate showed a significant improvement in functional disability and an increased risk of withdrawal (RR 1.78, 95% CI 1.23 to 2.60; 2 studies, n=285). There were more adverse events for topiramate-treated patients, particularly paraesthesia, weight loss, appetite decrease and memory difficulty.

Comment: The quality of evidence is downgraded by study quality (lack of allocation concealment, high drop-out rate), imprecise results (few studies in comparisons) and indirectness (short follow-up time).

References

  • Bruno E, Nicoletti A, Quattrocchi G et al. Topiramate for essential tremor. Cochrane Database Syst Rev 2017;4():CD009683. [PubMed]

Primary/Secondary Keywords