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Psychiatry and Clinical Neurosciences Dec 2008Postural tremor is the most common movement disorder in psychiatry, and often a difficult problem for clinicians. It can be classified as physiological, essential,... (Review)
Review
Postural tremor is the most common movement disorder in psychiatry, and often a difficult problem for clinicians. It can be classified as physiological, essential, drug-induced, and postural tremor in Parkinson's disease. Drugs used in psychiatry that can produce postural tremor, include lithium, valproic acid, lamotrigine, antidepressants, and neuroleptics. Clinical characteristics of postural tremor induced by each of these drugs are described. Pharmacological strategies for therapy in disabling drug-induced tremor include beta-blockers, primidone, gabapentin, topiramate, and benzodiazepines; their utility, doses and side-effects are also discussed.
Topics: Biomechanical Phenomena; Humans; Mental Disorders; Muscle, Skeletal; Parkinson Disease; Psychotropic Drugs; Tremor
PubMed: 19067999
DOI: 10.1111/j.1440-1819.2008.01877.x -
Bailliere's Clinical Neurology Dec 1996The major established drugs used in the management of epilepsy are carbamazepine, valproic acid, phenytoin, phenobarbital, primidone, ethosuximide and benzodiazepine... (Review)
Review
The major established drugs used in the management of epilepsy are carbamazepine, valproic acid, phenytoin, phenobarbital, primidone, ethosuximide and benzodiazepine drugs. Carbamazepine and phenytoin are used mainly in the treatment of partial seizures and primarily or secondarily generalized tonic-clonic seizures. Valproic acid is effective against all types of seizures, but it is used most extensively in the management of generalized epilepsies. Ethosuximide is effective against absence seizures. Phenobarbital and primidone are effective against all types of seizures (except for absences) although they are less commonly used because of their sedative properties and adverse effects on cognition. Benzodiazepines are most valuable in the treatment of status epilepticus, but their long-term use is often associated with undesirable sedation and development of tolerance to their antiepileptic effect. Irrespective of the drug used, optimal clinical management requires individualization of dosage and dosing schedules based on careful evaluation of clinical response and sound knowledge of the pharmacokinetics and interaction potential of the individual compounds. Monitoring serum drug concentrations may provide a useful guide to dosage adjustments, particularly in the case of phenytoin, which shows dose-dependent kinetics within the therapeutic dosage range.
Topics: Anticonvulsants; Barbiturates; Benzodiazepines; Carbamazepine; Epilepsy; Humans; Phenytoin; Succinimides; Valproic Acid
PubMed: 9068876
DOI: No ID Found -
The Turkish Journal of Pediatrics 2018Acar T, Alkan G, Çaksen H, Ertekin B, Ergin M, Koçak S, Cander B. Phenytoin induced dystonia. Turk J Pediatr 2018; 60: 111-112. The abnormalities of dopaminergic...
Acar T, Alkan G, Çaksen H, Ertekin B, Ergin M, Koçak S, Cander B. Phenytoin induced dystonia. Turk J Pediatr 2018; 60: 111-112. The abnormalities of dopaminergic activity in the basal ganglia have been emphasized to be effective in dystonia. We hereby report a case of a 2.5-year-old male patient who presented with tonic-clonic sezures and who developed dystonia after being given phenytoin. Biperidene hydrochloride was administered intramuscularly; primidone was added to the treatment regimen. After a 7-day-follow-up at the hospital, the patient had no dystonia and was discharged.
Topics: Anticonvulsants; Child, Preschool; Dystonia; Epilepsy; Humans; Male; Phenytoin; Primidone
PubMed: 30102491
DOI: 10.24953/turkjped.2018.01.019 -
Canadian Medical Association Journal Jun 1963The main clinical types of epilepsy and their treatment are described. The treatment of choice in petit mal epilepsy is trimethadione (Trimedone) 0.3 g., three to six...
The main clinical types of epilepsy and their treatment are described. The treatment of choice in petit mal epilepsy is trimethadione (Trimedone) 0.3 g., three to six times a day, or acetazolamide (Diamox) 125-250 mg., three to four times a day. Phenobarbital is usually given as well to prevent grand mal seizures. Diphenylhydantoin sodium (Dilantin Sodium), 100 mg., and/or phenobarbital, 30-100 mg., three to four times a day, is recommended in patients with focal and grand mal epilepsy. Psychomotor automatisms are a form of focal seizure. Primidone (Mysoline), in doses of 125-250 mg. two to three times a day, is a very useful anticonvulsant in patients with myoclonic features, psychomotor automatisms and grand mal seizures. Primidone should be started in small doses. Drug reactions, especially cerebellar ataxia in the case of diphenylhydantoin and blood dyscrasias in the case of some drugs, should be recognized. Excessive drowsiness can be avoided by proper dosage and proper timing of drug administration. Patients should be seen regularly at least two to three times a year. The objective of treatment is to achieve optimum control of seizures by using the appropriate drug in adequate dosage. Social adaptation is good in the majority of patients, who should be encouraged to carry on their life independently, usually free to marry and have children. Attention to special occupational hazards has to be considered. Education of employers and employees is often necessary. Special work arrangements are occasionally indicated for selected patients. Patients should be seizure-free for two to three years before permission is given to drive an automobile.
Topics: Acetazolamide; Anticonvulsants; Automatism; Child; Epilepsy; Epilepsy, Absence; Epilepsy, Tonic-Clonic; Humans; Phenobarbital; Phenytoin; Primidone; Seizures
PubMed: 13969008
DOI: No ID Found -
The Western Journal of Medicine Jun 1995Tremor is commonly encountered in medical practice, but can be difficult to diagnose and manage. It is an involuntary rhythmic oscillation of a body part produced by... (Review)
Review
Tremor is commonly encountered in medical practice, but can be difficult to diagnose and manage. It is an involuntary rhythmic oscillation of a body part produced by reciprocally innervated antagonist muscles. Tremors vary in frequency and amplitude and are influenced by physiologic and psychological factors and drugs. Categorization is based on position, posture, and the movement necessary to elicit the tremor. A resting tremor occurs when the body part is in repose. A postural tremor occurs with maintained posture and kinetic tremor with movement. Various pathologic conditions are associated with tremors. Essential tremor, which is the most common, is postural and kinetic, with a frequency between 4 and 8 Hz, and involves mainly the upper extremities and head. Essential tremor responds to treatment with primidone, beta-blockers, and benzodiazepines. Parkinson's disease causes a 4- to 6-Hz resting tremor in the arms and legs that responds to the use of anticholinergics and a combination of carbidopa and levodopa. Tremor can also be a manifestation of Wilson's disease, lesions of the cerebellum and midbrain, peripheral neuropathy, trauma, alcohol, and conversion disorders. Treatment should be directed to the underlying condition. Stereotactic thalamotomy of thalamic stimulation is a last resort.
Topics: Humans; Movement; Posture; Rest; Tremor
PubMed: 7618310
DOI: No ID Found -
British Medical Journal (Clinical... May 1984
Topics: Humans; Primidone; Propranolol; Tremor
PubMed: 6426631
DOI: 10.1136/bmj.288.6429.1536-c -
British Medical Journal Nov 1969
Topics: Adult; Child; Epilepsies, Partial; Epilepsy; Epilepsy, Absence; Epilepsy, Temporal Lobe; Epilepsy, Tonic-Clonic; Ethosuximide; Female; Folic Acid Deficiency; Humans; Male; Phenobarbital; Phenytoin; Pregnancy; Primidone; Psychoses, Substance-Induced; Thiazines
PubMed: 4390562
DOI: 10.1136/bmj.4.5678.281 -
Pain May 2017The melastatin-related transient receptor potential (TRP) channel TRPM3 is a nonselective cation channel expressed in nociceptive neurons and activated by heat. Because...
The melastatin-related transient receptor potential (TRP) channel TRPM3 is a nonselective cation channel expressed in nociceptive neurons and activated by heat. Because TRPM3-deficient mice show inflammatory thermal hyperalgesia, pharmacological inhibition of TRPM3 may exert antinociceptive properties. Fluorometric Ca influx assays and a compound library containing approved or clinically tested drugs were used to identify TRPM3 inhibitors. Biophysical properties of channel inhibition were assessed using electrophysiological methods. The nonsteroidal anti-inflammatory drug diclofenac, the tetracyclic antidepressant maprotiline, and the anticonvulsant primidone were identified as highly efficient TRPM3 blockers with half-maximal inhibition at 0.6 to 6 μM and marked specificity for TRPM3. Most prominently, primidone was biologically active to suppress TRPM3 activation by pregnenolone sulfate (PregS) and heat at concentrations markedly lower than plasma concentrations commonly used in antiepileptic therapy. Primidone blocked PregS-induced Cai influx through TRPM3 by allosteric modulation and reversibly inhibited atypical inwardly rectifying TRPM3 currents induced by coapplication of PregS and clotrimazole. In vivo, analgesic effects of low doses of primidone were demonstrated in mice, applying PregS- and heat-induced pain models, including inflammatory hyperalgesia. Thus, applying the approved drug at concentrations that are lower than those needed to induce anticonvulsive effects offers a shortcut for studying physiological and pathophysiological roles of TRPM3 in vivo.
Topics: Adrenergic Uptake Inhibitors; Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Calcium; Diclofenac; Disease Models, Animal; Dose-Response Relationship, Drug; Ganglia, Spinal; HEK293 Cells; Humans; Hyperalgesia; Male; Maprotiline; Membrane Potentials; Mice; Mice, Inbred C57BL; Neurons; Pain; Pain Threshold; Patch-Clamp Techniques; Pregnenolone; Primidone; Rats; TRPM Cation Channels
PubMed: 28106668
DOI: 10.1097/j.pain.0000000000000846 -
Tidsskrift For Den Norske Laegeforening... Oct 2008Essential tremor is probably the most common movement disorder. Still, the mechanisms underlying this condition are largely unknown. We have reason to believe that... (Review)
Review
BACKGROUND
Essential tremor is probably the most common movement disorder. Still, the mechanisms underlying this condition are largely unknown. We have reason to believe that essential tremor is under-diagnosed, and that many patients because of this do not receive adequate treatment.
MATERIAL AND METHODS
This review is based on own clinical experience, non-systematic search in the PubMed database, and on the available international consensus documents.
RESULTS AND DISCUSSION
Essential tremor usually presents as action tremor with postural tremor as the most prominent feature. It typically starts in the arms, but may spread and include head tremor in one third of the patients. Tremor in other parts of the body is seen less frequently. Ethanol may relieve the tremor. Essential tremor usually starts in adults and progresses with age. The prevalence is unknown, but is probably in the range 0.4-3.9%. The cause is unknown, but many families seem to have an autosomal dominant inheritance. Three associated loci have been found, but genes have not been identified. Essential tremor is often considered a neurodegenerative disorder, but receptor mechanisms may also be important. Some patients also show other neurological signs like cerebellar ataxia. New findings indicate that there are two neuropathological types of essential tremor, one is associated with cerebellar Purkinje cell pathology and one with brain stem Lewy bodies. Treatment is only symptomatic. Propranolol and primidone are the first choice drugs, but at least 30% of the patients have insufficient symptomatic relief from drug therapy. Neurosurgical treatment with thalamic deep brain stimulation is an effective alternative for the most severely disabled patients.
Topics: Adult; Diagnosis, Differential; Essential Tremor; Humans; Tremor
PubMed: 18846147
DOI: No ID Found -
NPJ Genomic Medicine Aug 2022Essential tremor (ET) is one of the most common movement disorders, affecting nearly 5% of individuals over 65 years old. Despite this, few genetic risk loci for ET have...
Essential tremor (ET) is one of the most common movement disorders, affecting nearly 5% of individuals over 65 years old. Despite this, few genetic risk loci for ET have been identified. Recent advances in pharmacogenomics have previously been useful to identify disease related molecular targets. Notably, gene expression has proven to be quite successful for the inference of drug response in cell models. We sought to leverage this approach in the context of ET where many patients are responsive to two drugs: propranolol and primidone. In this study, cerebellar DAOY and neural progenitor cells were treated for 5 days with clinical concentrations of propranolol and primidone, after which RNA-sequencing was used to identify convergent differentially expressed genes across treatments. Propranolol was found to affect the expression of genes previously associated with ET and other movement disorders such as TRAPPC11. Pathway enrichment analysis of these convergent drug-targeted genes identified multiple terms related to calcium signaling, endosomal sorting, axon guidance, and neuronal morphology. Furthermore, genes targeted by ET drugs were enriched within cell types having high expression of ET-related genes in both cortical and cerebellar tissues. Altogether, our results highlight potential cellular and molecular mechanisms associated with tremor reduction and identify relevant genetic biomarkers for drug-responsiveness in ET.
PubMed: 35927430
DOI: 10.1038/s41525-022-00318-9