TY - JOUR
T1 - Treatment of essential tremor
T2 - Are there issues we are overlooking?
AU - Louis, Elan D.
PY - 2012
Y1 - 2012
N2 - Background: Essential tremor (ET) is one of the most common neurological diseases. Although a large number of medications have been tested, there are only two first-line medications, primidone and propranolol, which is a situation that has not changed in approxi-mately 30 years. Several recent reviews have summarized the current pharmacotherapeutic options for ET and the approach to the management of ET patients. Yet there remain a number of important issues, both scientific and clinical, that have not been broached in the literature and that have therapeutic implications. Objectives: To introduce several clin-ical and scientific issues that have not formally entered the published literature on the treatment of ET. Methods: In September 2011, materials for this article were gathered during a literature search of PubMed using the following terms: ET, clinical, clinical trial, treatment, medications, therapeutics. English-language articles were selected for further review. Results: The paper focuses on several topics that have received scant or no dis-cussion in the published literature on ET therapeutics. These topics are as follows: the nature of the underlying disease pathophysiology, the presence of pathological hetero-geneity, the complexity of cellular and neurochemical changes which may be underlying this disorder, the presence of clinical heterogeneity, the selection of treatment endpoints, the effects of diagnostic uncertainty, the presence of cognitive and psychiatric features in ET, the identification of possible modifiable risk factors, and the absence of any neuropro-tective therapies. Conclusion: The author has identified several topics that have received scant or no discussion in the published literature on ET therapeutics. Further discussion of the issues raised here may lead to improvements in clinical trial methodologies as well as facilitate the development of fresh approaches to pharmacotherapy.
AB - Background: Essential tremor (ET) is one of the most common neurological diseases. Although a large number of medications have been tested, there are only two first-line medications, primidone and propranolol, which is a situation that has not changed in approxi-mately 30 years. Several recent reviews have summarized the current pharmacotherapeutic options for ET and the approach to the management of ET patients. Yet there remain a number of important issues, both scientific and clinical, that have not been broached in the literature and that have therapeutic implications. Objectives: To introduce several clin-ical and scientific issues that have not formally entered the published literature on the treatment of ET. Methods: In September 2011, materials for this article were gathered during a literature search of PubMed using the following terms: ET, clinical, clinical trial, treatment, medications, therapeutics. English-language articles were selected for further review. Results: The paper focuses on several topics that have received scant or no dis-cussion in the published literature on ET therapeutics. These topics are as follows: the nature of the underlying disease pathophysiology, the presence of pathological hetero-geneity, the complexity of cellular and neurochemical changes which may be underlying this disorder, the presence of clinical heterogeneity, the selection of treatment endpoints, the effects of diagnostic uncertainty, the presence of cognitive and psychiatric features in ET, the identification of possible modifiable risk factors, and the absence of any neuropro-tective therapies. Conclusion: The author has identified several topics that have received scant or no discussion in the published literature on ET therapeutics. Further discussion of the issues raised here may lead to improvements in clinical trial methodologies as well as facilitate the development of fresh approaches to pharmacotherapy.
KW - Clinical
KW - Essential tremor
KW - Pharmacology
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84865839659&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84865839659&partnerID=8YFLogxK
U2 - 10.3389/fneur.2011.00091
DO - 10.3389/fneur.2011.00091
M3 - Article
C2 - 22275907
AN - SCOPUS:84865839659
SN - 1664-2295
VL - JAN
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - Article 91
ER -