Survey of medication usage patterns among essential tremor patients: movement disorder specialists vs. general neurologists.
BACKGROUND
Although small treatment trials have examined the efficacy of front-line medications in tremor reduction in essential tremor (ET), an overall survey of pharmacological management has not been undertaken in a large sample of ET cases.


OBJECTIVE
To conduct a survey of medication usage among several hundred ET patients.


METHODS
A computerized database at the Neurological Institute of New York was used to identify 223 ET patients cared for by movement disorder neurologists and 37 cared for by general neurologists. Each had been seen one or more times within past five years. Lifetime treatment data were abstracted from clinical records.


RESULTS
One-hundred-sixty-three (73.1%) of 223 patients cared for by movement disorder neurologists had taken medication for ET during their lifetime; 53/163 (32.5%) had taken ≥4 medications; 31/163 (19.0%) had taken ≥5 medications; and 3 (1.8%), ≥10 medications. Nearly three-quarters (158/223 [70.9%]) had taken primidone or propranolol, yet 89/158 (56.3%) had discontinued both. Among 11 patients who had undergone ET surgery, the mean number of ET medications tried was 6.0 ± 2.8 (range = 3-12). Medication usage by general neurologists was less than by movement disorder specialists (p < 0.001). One-third of general neurologists' patients (14/37 [37.8%]) had taken primidone or propranolol at some point and 6/14 (42.9%) had discontinued both.


CONCLUSIONS
In this large survey, a substantial proportion of ET patients failed treatment with both front-line medications. Among patients seeing movement disorder specialists, the number of medications they had had to try was sizable. These data demonstrate the limitations of current pharmacological options for ET.
Diaz
Nancy L
NL
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Louis
Elan D
ED
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004363:Drug Utilization; D020329:Essential Tremor / Q000188:drug therapy*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology; D009518:New York; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011324:Primidone / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D013038:Specialization; D055815:Young Adult
D000927:Anticonvulsants; D011324:Primidone; D011433:Propranolol