Tremor topiramate

Topiramate, another antiepileptic drug, may also be helpful in a dose of 400 mg daily, built up gradually. Small quantities of alcohol may suppress essential tremor but only for a short time. Alprazolam (in doses up to 3 mg daily) or gabapentin (100-2400 mg/d) is helpful in some patients. Others are helped by intramuscular injections of botulinum toxin. Thalamic stimulation by an implanted electrode and stimulator is often worthwhile in advanced cases refractory to pharmacotherapy. Diazepam, chlordiazepoxide, mephenesin, and antiparkinsonism agents have been advocated in the past but are generally worthless. Anecdotal reports of benefit from mirtazapine were not confirmed in a double-blind study, which found no effect on the tremor in most patients. 

Risperidone has also been used in combination with topiramate in a Spanish multicenter study in 58 patients (28 men and 30 women mean age 41 years) with bipolar I disorder, with manic but not mixed episodes (20). Risperidone (mean dose 2.7 mg/day) and topiramate (mean dose 236 mg/day) were started with a maximum 48-hour time difference risperidone was used for acute manic symptoms and topiramate for longer-term stabilization and prevention of relapse. The incidence of any adverse event was 64%, mostly somnolence, paresthesia, dizziness, tremor, weight loss (n = 27 mean change -1.1 kg), extrapyramidal disorders, gastrointestinal effects, and cognitive disturbances. One patient developed tardive dyskinesia during the study and there were five dropouts because of adverse effects adverse effects that required withdrawal of risperidone but not topiramate were amenorrhea (n = 3) and sexual dysfunction (n = 1). 

Galvez-Jimenez N, Hargreave M. Topiramate and essential tremor. Ann Neurol 2000 47(6) 837-8. 

Topiramate had a beneficial effect on benign essential tremor in an open study in nine patients (2). Six patients complained of fatigue and two discontinued therapy four complained of paresthesia. 

Myoclonic seizures consist of sudden, very brief, jerking contractions that may involve the entire body or be confined to limited areas, such as the face and neck. The contractions may affect Individual muscles or groups, with simultaneous contraction of both extensor and flexor muscles. These seizures occur In all age groups, with symptoms ranging from rapid tremors to falling down. No loss of consciousness Is detectable because of the brief duration of the seizure. Myoclonic seizures often occur In combination with other seizure types. Valproate and clonazepam are used most often to treat myoclonic seizures lamotrigine and topiramate also have shown some efficacy. 

Topiramate 21 h 200-600 mg Sedation, confusion, slurred speech, ataxia, tremor, anxiety, nenrousness. 

Nervous system In a review of several clinical studies of the use of topiramate in different indications (alcohol dependence, essential tremor, binge-eating disorder, bulimia nervosa, migraine, and epilepsy), the percentages of drug-induced nervous system adverse reactions, in particular paresthesia, differed greatly between the different disorders dropouts due to adverse events varied from 2% in those with bulimia nervosa to 29% in those with migraine [289 ]. 

A 42-year-old woman developed tremor and myoclonus after topiramate 50 mg/day was added to fluvoxamine 300 mg/day as an antimigraine agent [304 ]. 

Oulis P, Potagas C, Masdrakis VG, Thomopoulos Y, Kouzoupis AV, Soldatos CR. Reversible tremor and myoclonus associated with topiramate-fluvoxamine coadministration. Clin Neu-ropharmacol 2008 31(6) 366-7. 

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