Abstract
Essential tremor, a common adult pathologic tremor disorder, is characterized by action tremors. Mainstays of treatment include gabapentin, primidone, and propranolol. However, many patients obtain insufficient benefit or do not tolerate these medications (especially the elderly). Short-term studies demonstrate that zonisamide may be effective for essential tremor; however, long-term data are lacking. This is a case report of an 83-year-old, right-handed man with essential tremor of the upper extremities and head who previously failed several pharmacological treatments (defined as obtaining inadequate benefit from maximum tolerated dose) with gabapentin, nadalol, propranolol, and primidone and was initiated on zonisamide monotherapy. Long-term zonisamide therapy (200 mg daily) was well tolerated in this elderly patient and associated with clinically significant improvement of upper extremity tremor and clinically modest improvement in head tremor. The beneficial effects and tolerability were sustained over nearly 28 months of follow-up treatment.
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