TY - JOUR
T1 - Benefits and risks of pharmacological and surgical treatments for essential tremor
T2 - Disease mechanisms and current management
AU - Rincon, Fred
AU - Louis, Elan D.
PY - 2005/9
Y1 - 2005/9
N2 - Essential tremor (ET) is a neurological disease (and possibly a family of diseases) whose most recognisable feature is an action tremor of the hands and occasionally of the voice and head. Current data support the view that CNS γ-amino-butyric acid (GABA)-ergic mechanisms may underlie ET and that the tremor may be further modulated by peripheral (muscle) adrenoreceptors. Potential pharmacotherapeutic options, targeted to influence the activity of the neurotransmitter GABA within the CNS and the peripheral adrenergic receptors, are part of the current armamentarium to treat ET. As such, primidone and propranolol remain the mainstays of the therapy for ET. Intramuscular injections of botulinum toxin A may play a role in the treatment of voice and head tremor. Surgical options, which are reserved for patients with severe, medically-refractory tremor, provide adequate tremor control in the majority of patients. As with other progressive neurological disorders of late life, the ability to use neuroprotective medications to intervene in the developing disease to either slow or halt the progression of the pathological process, would involve an understanding of underlying disease mechanisms. The understanding of these mechanisms in ET is limited and further study of these mechanisms is critical for the development of such therapies.
AB - Essential tremor (ET) is a neurological disease (and possibly a family of diseases) whose most recognisable feature is an action tremor of the hands and occasionally of the voice and head. Current data support the view that CNS γ-amino-butyric acid (GABA)-ergic mechanisms may underlie ET and that the tremor may be further modulated by peripheral (muscle) adrenoreceptors. Potential pharmacotherapeutic options, targeted to influence the activity of the neurotransmitter GABA within the CNS and the peripheral adrenergic receptors, are part of the current armamentarium to treat ET. As such, primidone and propranolol remain the mainstays of the therapy for ET. Intramuscular injections of botulinum toxin A may play a role in the treatment of voice and head tremor. Surgical options, which are reserved for patients with severe, medically-refractory tremor, provide adequate tremor control in the majority of patients. As with other progressive neurological disorders of late life, the ability to use neuroprotective medications to intervene in the developing disease to either slow or halt the progression of the pathological process, would involve an understanding of underlying disease mechanisms. The understanding of these mechanisms in ET is limited and further study of these mechanisms is critical for the development of such therapies.
KW - Cerebellum
KW - Essential tremor (ET)
KW - Monoamine
KW - Treatment
KW - γ-amino-butyric acid (GABA)
UR - http://www.scopus.com/inward/record.url?scp=24344434201&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=24344434201&partnerID=8YFLogxK
U2 - 10.1517/14740338.4.5.899
DO - 10.1517/14740338.4.5.899
M3 - Review article
C2 - 16111452
AN - SCOPUS:24344434201
SN - 1474-0338
VL - 4
SP - 899
EP - 913
JO - Expert Opinion on Drug Safety
JF - Expert Opinion on Drug Safety
IS - 5
ER -