Antiepileptic drugs in essential tremor

Abstract

Essential tremor (ET) is characterized by postural and kinetic tremor and is no longer considered to be a disease of single pathological origin. The Quality Standards Subcommittee of the American Academy of Neurology (AAN) recently published evidence-based recommendations for the treatment of ET, which included Level B recommendations for the use of gabapentin and topiramate. However, a number of other antiepileptic drugs, including two in phase III development for epilepsy, have more recently been evaluated in ET or in animal models of ET. Clinical studies with levetiracetam have not confirmed the promising efficacy in a single-dose study. However, these and other studies with zonisamide have involved very small numbers of patients. Larger studies are required to evaluate the efficacy of antiepileptic drugs in ET. Preclinical studies in animal models of ET have demonstrated early evidence of efficacy for brivaracetam and lacosamide. Recent advances in the characterization of the disease and in the development of genetic models may enable the development of targeted and more effective symptomatic therapies.