title: Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian Movement Disorders Association.
abstract: Essential tremor (ET) is one of the most common movement disorders of adults, characterized by postural and kinetic tremor. It often causes embarrassment and more rarely serious disability, requiring treatment. To assess the current state of knowledge on ET therapy and produce recommendations based on the analysis of evidence the authors reviewed the literature regarding pharmacologic and surgical therapies, providing a quality assessment of the studies and the strength of recommendations for each treatment. A committee of experts selected clinical-based questions to guide the search. A systematic literature review was performed to identify all the studies conducted on patients with ET published until September 2010. Articles were classified according to GRADE evidence profile, a system for grading the quality of evidence and the strength of recommendation based on the quality of the studies. The quality of evidence was often rated as "low" or "very low" for the studies analyzed. Propranolol, long-acting propranolol, primidone, and topiramate are recommended as first-line therapy, with restrictions for their side effects. Arotinolol, sotalol, ICI 118.551 and LI 32.468 (experimental drugs), zonisamide, gabapentin, alprazolam, clozapine, and olanzapine are recommended as a second-line treatment. Botulinum toxin type A and thalamic deep-brain stimulation are recommended for refractory ET. The results highlight the need of well-designed direct comparison trials aimed at evaluating relative effectiveness and safety of the drugs currently used in clinical practice. Furthermore, additional controlled clinical trials are required to define other possible treatment strategies for ameliorating the management of ET.
authors.affiliation: Department GF Ingrassia, Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123, Catania, Italy. m.zappia@unict.it
authors.forename: Mario
authors.initials: M
authors.lastname: Zappia
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.forename: Elisa
authors.initials: E
authors.lastname: Bruno
authors.forename: Carlo
authors.initials: C
authors.lastname: Colosimo
authors.forename: Graziella
authors.initials: G
authors.lastname: Filippini
authors.forename: Paolo
authors.initials: P
authors.lastname: Martinelli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nicoletti
authors.forename: Graziella
authors.initials: G
authors.lastname: Quattrocchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Abbruzzese
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berardelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Allegra
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Aniello
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Elia
authors.forename: Davide
authors.initials: D
authors.lastname: Martino
authors.forename: Daniela
authors.initials: D
authors.lastname: Murgia
authors.forename: Marina
authors.initials: M
authors.lastname: Picillo
authors.forename: Giovanna
authors.initials: G
authors.lastname: Squintani
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards; D003024:Clozapine / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods / Q000592:standards; D020329:Essential Tremor / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009069:Movement Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017410:Practice Guidelines as Topic / Q000592:standards*; D011433:Propranolol / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D011433:Propranolol; D003024:Clozapine