Marlene Alonso-Juarez1, Diego Torres-Russotto2, Paulina Crespo-Morfin3, José Fidel Baizabal-Carvallo4. 1. National Polytechnic Institute, Mexico. 2. University of Nebraska Medical Center, Omaha, Nebraska, USA. 3. University of Guanajuato, Mexico. 4. University of Guanajuato, Mexico; Baylor College of Medicine, Houston, Texas, USA. Electronic address: baizabaljf@hotmail.com.
Abstract
BACKGROUND: Tremor is a known side-effect of anticonvulsants, particularly of valproate. However, there is a dearth of information regarding detailed clinical features and functional impact of valproate-induced tremor. METHODS: We studied a cohort of patients treated with anticonvulsants for neurological disorders, through blinded evaluations using the Clinical Rating Scale for Tremor (CRST); we compared the frequency, severity and functional impact of drug-induced tremor between patients treated with valproate and those treated with other anticonvulsants. RESULTS: From a cohort of 218 consecutive patients, 171 were fully evaluated; 118 patients were taking valproate alone or combined with other anticonvulsants and 53 patients were taking other anticonvulsants. Mean age (±SD) at evaluation of the cohort was 32 ± 13 years, females represented 55.6% of cases. Tremor was more frequently observed in patients taking valproate particularly postural upper limb tremor: 49% vs. 15% (right-side) (P < 0.001) and 48.3% vs. 13.2% (left-side), (P < 0.001); had a higher total CRST score: 12.14 vs. 3.06 (P < 0.001), and required more frequently treatment for drug-induced tremor: 23.7% vs. 5.6% (P=0.005) compared with patients taking other anticonvulsants. Among 118 patients taking valproate, women had a higher total CRST score compared with men: 14.54 ± 14.9 vs. 9.56 ± 9.55 (P=0.034). A weak correlation between the total CRST score, dose per Kg of valproate and serum levels of valproate were observed. CONCLUSIONS: Tremor is frequently observed in patients taking valproate and is severe enough to require treatment in about 24% of cases.
BACKGROUND:Tremor is a known side-effect of anticonvulsants, particularly of valproate. However, there is a dearth of information regarding detailed clinical features and functional impact of valproate-induced tremor. METHODS: We studied a cohort of patients treated with anticonvulsants for neurological disorders, through blinded evaluations using the Clinical Rating Scale for Tremor (CRST); we compared the frequency, severity and functional impact of drug-induced tremor between patients treated with valproate and those treated with other anticonvulsants. RESULTS: From a cohort of 218 consecutive patients, 171 were fully evaluated; 118 patients were taking valproate alone or combined with other anticonvulsants and 53 patients were taking other anticonvulsants. Mean age (±SD) at evaluation of the cohort was 32 ± 13 years, females represented 55.6% of cases. Tremor was more frequently observed in patients taking valproate particularly postural upper limb tremor: 49% vs. 15% (right-side) (P < 0.001) and 48.3% vs. 13.2% (left-side), (P < 0.001); had a higher total CRST score: 12.14 vs. 3.06 (P < 0.001), and required more frequently treatment for drug-induced tremor: 23.7% vs. 5.6% (P=0.005) compared with patients taking other anticonvulsants. Among 118 patients taking valproate, women had a higher total CRST score compared with men: 14.54 ± 14.9 vs. 9.56 ± 9.55 (P=0.034). A weak correlation between the total CRST score, dose per Kg of valproate and serum levels of valproate were observed. CONCLUSIONS:Tremor is frequently observed in patients taking valproate and is severe enough to require treatment in about 24% of cases.
Authors: Michel Sáenz-Farret; Marina A J Tijssen; Dawn Eliashiv; Robert S Fisher; Kapil Sethi; Alfonso Fasano Journal: CNS Drugs Date: 2022-07-21 Impact factor: 6.497
Authors: Mark Cook; Michael Murphy; Kristian Bulluss; Wendyl D'Souza; Chris Plummer; Emma Priest; Catherine Williams; Ashwini Sharan; Robert Fisher; Sharon Pincus; Eric Distad; Tom Anchordoquy; Dan Abrams Journal: EClinicalMedicine Date: 2020-05-03