Nonparkinsonism movement disorders in the elderly.
OBJECTIVE
The primary objective of this article is to review the clinical presentation and pharmacologic management of essential tremor and tardive dyskinesia.


METHODS
The MEDLINE (1966-August 2005), Cochrane Database of Systematic Reviews, and International Pharmaceutical Abstracts (1970-August 2005) databases were searched for original research and review articles published in English. The search terms were essential tremor and tardive dyskinesia. Reference lists from articles were also consulted.


RESULTS
Essential tremor is most commonly manifested as a postural or action tremor of the upper extremities. Midline regions such as the head and voice are also commonly affected. Based on review of the literature, propranolol and primidone are the current pharmacologic mainstays for treating essential tremor of the upper extremities. The choice of agent depends on patient-specific factors such as underlying medical conditions. Other agents with demonstrated efficacy include gabapentin and topiramate. Benzodiazepines are effective adjunctive agents, but should be utilized judiciously in the elderly. Botulinum toxin is effective for essential tremor of the voice and head. Surgery is very effective, but may not be appropriate in the frail elderly and should be avoided in the presence of cognitive impairment. Tardive dyskinesia is characterized by involuntary choreoathetoid movements of the orofacial region. For the management of tardive dyskinesia, emphasis is placed on primary prevention and early recognition of signs and symptoms. In some cases, discontinuation of the offending agent can result in reversal of symptoms. If a conventional neuroleptic is the causative agent, switching to an atypical antipsychotic may be helpful. Overall, few treatments have proven to be consistently useful. Other agents that may be helpful include acetylcholinesterase inhibitors, amantadine, baclofen, benzodiazepines, branched chain amino acids, gabapentin, levetiracetam, pyridoxine, verapamil, and vitamin E.


CONCLUSIONS
Current pharmacologic agents for essential tremor can be expected to provide partial benefit. However, agents for the symptomatic management of tardive dyskinesia are limited, and additional research is warranted in this area.
Chen
Jack J
JJ
School of Pharmacy, Loma Linda University, California 92350, USA. jjchen@llu.edu
Lee
Kelly C
KC
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D020329:Essential Tremor / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D009069:Movement Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014810:Vitamin E / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D000319:Adrenergic beta-Antagonists; D000927:Anticonvulsants; D001569:Benzodiazepines; D014810:Vitamin E