Abstract
Background: Essential Tremor (ET) is likely the most frequent movement disorder. In this review, we have summarized the current pharmacological options for the treatment of this disorder and discussed several future options derived from drugs tested in experimental models of ET or from neuropathological data.
Methods: A literature search was performed on the pharmacology of essential tremors using PubMed Database from 1966 to July 31, 2019.
Results: To date, the beta-blocker propranolol and the antiepileptic drug primidone are the drugs that have shown higher efficacy in the treatment of ET. Other drugs tested in ET patients have shown different degrees of efficacy or have not been useful.
Conclusion: Injections of botulinum toxin A could be useful in the treatment of some patients with ET refractory to pharmacotherapy. According to recent neurochemical data, drugs acting on the extrasynaptic GABAA receptors, the glutamatergic system or LINGO-1 could be interesting therapeutic options in the future.
Keywords: Essential tremor, neuropharmacology, beta-blockers, primidone, antiepileptic drugs, gap-junction blockers, experimental treatment.
Graphical Abstract
[http://dx.doi.org/10.1111/ane.12148] [PMID: 23682623]
[http://dx.doi.org/10.1016/B978-0-444-63233-3.00015-4] [PMID: 29325613]
[http://dx.doi.org/10.1159/000103646] [PMID: 17570916]
[http://dx.doi.org/10.2174/0929867325666181112094330] [PMID: 30417772]
[http://dx.doi.org/10.1212/WNL.25.3.259] [PMID: 1167633]
[http://dx.doi.org/10.1212/WNL.34.2.221] [PMID: 6538013]
[http://dx.doi.org/10.1002/mds.10553] [PMID: 14639668]
[http://dx.doi.org/10.1002/mds.23846] [PMID: 22021159]
[http://dx.doi.org/10.2165/00002018-200326070-00003] [PMID: 12735785]
[http://dx.doi.org/10.2174/9781608057757113020007]
[http://dx.doi.org/10.1371/journal.pmed.1000097] [PMID: 19621072]
[http://dx.doi.org/10.1002/mds.27700] [PMID: 31046186]
[http://dx.doi.org/10.1152/ajpendo.2001.280.2.E199] [PMID: 11158920]
[PMID: 5082025]
[PMID: 4945929]
[http://dx.doi.org/10.1016/S0140-6736(72)90431-X]
[http://dx.doi.org/10.1111/j.1600-0404.1973.tb01280.x] [PMID: 4567748]
[http://dx.doi.org/10.1056/NEJM197405022901802] [PMID: 4594525]
[http://dx.doi.org/10.1212/WNL.25.11.1041] [PMID: 1237822]
[PMID: 195382]
[http://dx.doi.org/10.1212/WNL.26.1.27] [PMID: 1107883]
[PMID: 791468]
[http://dx.doi.org/10.1002/ana.410010210] [PMID: 196540]
[http://dx.doi.org/10.1212/WNL.27.5.439] [PMID: 558548]
[http://dx.doi.org/10.1111/j.1365-2125.1979.tb00964.x] [PMID: 444370]
[http://dx.doi.org/10.1136/jnnp.42.9.831] [PMID: 501384]
[http://dx.doi.org/10.1002/ana.410090110] [PMID: 7212666]
[http://dx.doi.org/10.1002/ana.410130210] [PMID: 6338809]
[http://dx.doi.org/10.1136/jnnp.46.5.393] [PMID: 6101174]
[http://dx.doi.org/10.1212/WNL.35.10.1494] [PMID: 4033931]
[http://dx.doi.org/10.1001/archneur.1986.00520010038018] [PMID: 3942513]
[http://dx.doi.org/10.1111/j.1600-0404.1990.tb00982.x] [PMID: 2375239]
[http://dx.doi.org/10.1212/WNL.35.1.108] [PMID: 3965982]
[http://dx.doi.org/10.1136/jnnp.51.3.379] [PMID: 3283296]
[http://dx.doi.org/10.1590/S0004-282X2004000100015] [PMID: 15122439]
[http://dx.doi.org/10.1212/WNL.34.8.1077] [PMID: 6379505]
[http://dx.doi.org/10.1097/00002826-199212000-00004] [PMID: 1477848]
[http://dx.doi.org/10.1007/s00415-018-9052-z] [PMID: 30209649]
[http://dx.doi.org/10.3348/kjr.2015.16.5.967] [PMID: 26357492]
[http://dx.doi.org/10.1212/WNL.0b013e318236f0fd] [PMID: 22013182]
[http://dx.doi.org/10.1007/s00415-012-6628-x] [PMID: 22886006]
[http://dx.doi.org/10.1056/NEJM197908093010617] [PMID: 450027]
[http://dx.doi.org/10.1016/S0140-6736(80)91474-9] [PMID: 6103362]
[http://dx.doi.org/10.1056/NEJM197909203011215] [PMID: 471008]
[http://dx.doi.org/10.1001/archneur.1980.00500580092022] [PMID: 7417066]
[http://dx.doi.org/10.1136/jnnp.45.10.893] [PMID: 6815306]
[http://dx.doi.org/10.1136/jnnp.44.9.814] [PMID: 7031187]
[PMID: 6344590]
[http://dx.doi.org/10.1136/jnnp.46.8.710] [PMID: 6310053]
[http://dx.doi.org/10.1001/archneur.1984.04050140069026] [PMID: 6691818]
[http://dx.doi.org/10.1038/clpt.1984.182] [PMID: 6467791]
[http://dx.doi.org/10.1136/jnnp.44.8.677] [PMID: 7028921]
[http://dx.doi.org/10.1111/j.1600-0404.1982.tb03141.x] [PMID: 7148397]
[http://dx.doi.org/10.1212/WNL.33.8.1074] [PMID: 6683807]
[http://dx.doi.org/10.1007/BF00314194] [PMID: 2892895]
[http://dx.doi.org/10.1016/S1353-8020(03)00029-4] [PMID: 12853233]
[http://dx.doi.org/10.1212/WNL.38.4.650] [PMID: 2451192]
[http://dx.doi.org/10.2169/internalmedicine.35.861] [PMID: 8968797]
[http://dx.doi.org/10.1097/00002826-198710000-00007] [PMID: 3332615]
[http://dx.doi.org/10.1016/B978-0-12-374105-9.00307-5]
[http://dx.doi.org/10.1097/WNF.0000000000000127] [PMID: 26757316]
[http://dx.doi.org/10.1136/bmj.282.6259.178] [PMID: 6779938]
[http://dx.doi.org/10.1136/jnnp.44.7.650] [PMID: 7288456]
[http://dx.doi.org/10.1136/bmj.285.6342.608] [PMID: 6819034]
[http://dx.doi.org/10.1136/jnnp.48.9.911] [PMID: 3900296]
[http://dx.doi.org/10.1212/WNL.36.1.121] [PMID: 3941767]
[http://dx.doi.org/10.1007/BF00314310] [PMID: 3367165]
[http://dx.doi.org/10.1136/jnnp.49.1.64] [PMID: 3514797]
[http://dx.doi.org/10.1111/j.1600-0404.1987.tb05455.x] [PMID: 2887081]
[http://dx.doi.org/10.1212/WNL.39.12.1587] [PMID: 2586774]
[http://dx.doi.org/10.1001/jamaoto.2015.2849] [PMID: 26660910]
[http://dx.doi.org/10.1097/00002826-199002000-00007] [PMID: 2306749]
[http://dx.doi.org/10.1212/WNL.41.4.602] [PMID: 2011265]
[http://dx.doi.org/10.1212/WNL.38.5.808] [PMID: 3283599]
[http://dx.doi.org/10.1002/mds.870060112] [PMID: 2005924]
[http://dx.doi.org/10.1136/jnnp.44.10.932] [PMID: 7031184]
[http://dx.doi.org/10.1212/WNL.33.3.296] [PMID: 6338416]
[http://dx.doi.org/10.1212/WNL.35.12.1784] [PMID: 3906431]
[http://dx.doi.org/10.1016/S1353-8020(03)00070-1] [PMID: 14499204]
[http://dx.doi.org/10.1002/mds.10083] [PMID: 11921128]
[http://dx.doi.org/10.1159/000095702] [PMID: 16960452]
[http://dx.doi.org/10.1007/BF02685892] [PMID: 17627038]
[http://dx.doi.org/10.1002/mds.21321] [PMID: 17265458]
[http://dx.doi.org/10.1016/j.parkreldis.2012.11.014] [PMID: 23254160]
[http://dx.doi.org/10.1001/archneur.56.4.475] [PMID: 10199338]
[http://dx.doi.org/10.33588/rn.3604.2002313] [PMID: 12599126]
[http://dx.doi.org/10.1002/1531-8257(200007)15:4<678:AID-MDS1012>3.0.CO;2-0] [PMID: 10928578]
[http://dx.doi.org/10.1002/mds.870130315] [PMID: 9613738]
[http://dx.doi.org/10.33588/rn.3108.2000111] [PMID: 11082893]
[http://dx.doi.org/10.1002/mds.22094] [PMID: 18759354]
[http://dx.doi.org/10.1002/1531-8249(200006)47:6<837:AID-ANA24>3.0.CO;2-2] [PMID: 10852557]
[http://dx.doi.org/10.1097/00002826-200311000-00006] [PMID: 14646607]
[http://dx.doi.org/10.1212/WNL.59.1.132] [PMID: 12105323]
[http://dx.doi.org/10.1212/01.wnl.0000200779.03748.0f] [PMID: 16436648]
[http://dx.doi.org/10.1097/WNF.0b013e3180d09969] [PMID: 18382182]
[http://dx.doi.org/10.1097/00002826-200603000-00007] [PMID: 16614542]
[PMID: 19008799]
[http://dx.doi.org/10.1097/MD.0000000000001809] [PMID: 26512577]
[PMID: 28409827]
[http://dx.doi.org/10.1097/01.WNF.0000220823.80640.44] [PMID: 16772820]
[http://dx.doi.org/10.1097/01.WNF.0000220825.65393.93] [PMID: 16772816]
[http://dx.doi.org/10.1002/mds.20147] [PMID: 15390011]
[http://dx.doi.org/10.1212/01.WNL.0000154596.21335.2E] [PMID: 15781835]
[http://dx.doi.org/10.1097/00002826-200411000-00004] [PMID: 15613931]
[http://dx.doi.org/10.1002/mds.20437] [PMID: 15756652]
[http://dx.doi.org/10.33588/rn.4503.2006227] [PMID: 17661270]
[http://dx.doi.org/10.1097/WNF.0b013E31807A32C6] [PMID: 18090460]
[http://dx.doi.org/10.1016/j.neuropharm.2010.05.012] [PMID: 20547167]
[http://dx.doi.org/10.1016/j.parkreldis.2004.09.004] [PMID: 15734668]
[http://dx.doi.org/10.1002/mds.21717] [PMID: 17853481]
[PMID: 18297619]
[http://dx.doi.org/10.1002/mds.22418] [PMID: 19117357]
[http://dx.doi.org/10.1002/mds.21282] [PMID: 17149715]
[http://dx.doi.org/10.1097/WNF.0b013e318074dd4f] [PMID: 18090459]
[http://dx.doi.org/10.1111/j.1468-1331.2008.02296.x] [PMID: 18754763]
[http://dx.doi.org/10.1097/01.jcp.0000227350.44664.50] [PMID: 16855471]
[PMID: 28836659]
[http://dx.doi.org/10.1002/mds.21211] [PMID: 17089400]
[http://dx.doi.org/10.1002/mds.21629] [PMID: 17580330]
[http://dx.doi.org/10.1016/j.jns.2009.06.044] [PMID: 19631949]
[http://dx.doi.org/10.1002/mds.25264] [PMID: 23238907]
[http://dx.doi.org/10.1016/j.ejphar.2008.06.038] [PMID: 18585381]
[http://dx.doi.org/10.1002/mds.23296] [PMID: 20925072]
[PMID: 27625899]
[http://dx.doi.org/10.1016/j.parkreldis.2018.10.010] [PMID: 30318448]
[http://dx.doi.org/10.1345/aph.1H131] [PMID: 16968828]
[http://dx.doi.org/10.1002/mds.22872] [PMID: 20201005]
[http://dx.doi.org/10.1159/000116142] [PMID: 3622581]
[http://dx.doi.org/10.1212/WNL.41.2_Part_1.311] [PMID: 1992381]
[http://dx.doi.org/10.1097/00002826-199104000-00005] [PMID: 2015612]
[http://dx.doi.org/10.1097/00002826-199202000-00003] [PMID: 1349506]
[PMID: 8481198]
[http://dx.doi.org/10.1159/000117131] [PMID: 7671982]
[http://dx.doi.org/10.1097/00002826-199310000-00011] [PMID: 8221708]
[http://dx.doi.org/10.1097/00002826-199310000-00010] [PMID: 8221707]
[PMID: 7856472]
[http://dx.doi.org/10.1212/WNL.45.8.1523] [PMID: 7644052]
[http://dx.doi.org/10.1016/j.ejphar.2011.01.004] [PMID: 21256842]
[http://dx.doi.org/10.3389/fneur.2019.00597] [PMID: 31244760]
[http://dx.doi.org/10.1212/WNL.38.2.241] [PMID: 3340287]
[http://dx.doi.org/10.1007/s100720070069] [PMID: 11286044]
[http://dx.doi.org/10.1371/journal.pone.0093159] [PMID: 24667763]
[PMID: 26638213]
[http://dx.doi.org/10.1212/WNL.37.3.471] [PMID: 3822141]
[http://dx.doi.org/10.1097/00002826-198403000-00004] [PMID: 6367975]
[http://dx.doi.org/10.1002/mds.20940] [PMID: 16773639]
[http://dx.doi.org/10.1007/s13311-012-0121-1] [PMID: 22454323]
[http://dx.doi.org/10.1212/WNL.62.12.2320] [PMID: 15210907]
[http://dx.doi.org/10.1212/01.WNL.0000101722.95137.19] [PMID: 14718713]
[http://dx.doi.org/10.1172/JCI83621] [PMID: 26927672]
[http://dx.doi.org/10.1212/WNL.0b013e3182840c4f] [PMID: 23408867]
[http://dx.doi.org/10.1002/lary.27695] [PMID: 30585335]
[http://dx.doi.org/10.1046/j.1468-1331.2003.00534.x] [PMID: 12534999]
[http://dx.doi.org/10.1016/j.clineuro.2005.01.002] [PMID: 16311142]
[http://dx.doi.org/10.1212/WNL.50.4.1183-a] [PMID: 9566425]
[http://dx.doi.org/10.1111/j.1600-0404.1986.tb03279.x] [PMID: 3521185]
[http://dx.doi.org/10.1097/00004714-199406000-00015] [PMID: 8027423]
[http://dx.doi.org/10.1002/1531-8257(199905)14:3<468:AID-MDS1013>3.0.CO;2-M] [PMID: 10348471]
[http://dx.doi.org/10.1097/00002826-200211000-00004] [PMID: 12469002]
[http://dx.doi.org/10.1002/ana.410090219] [PMID: 7235638]
[http://dx.doi.org/10.1002/ana.410160517] [PMID: 6508244]
[http://dx.doi.org/10.1002/ana.410190125] [PMID: 3947045]
[http://dx.doi.org/10.1002/mds.20676] [PMID: 16229019]
[http://dx.doi.org/10.1097/WNF.0b013e31824687bf] [PMID: 22318193]
[http://dx.doi.org/10.1111/cns.12467] [PMID: 26459182]
[http://dx.doi.org/10.1016/S0025-6196(12)61721-2] [PMID: 1921495]
[http://dx.doi.org/10.1212/WNL.42.7.1394] [PMID: 1620352]
[http://dx.doi.org/10.1212/WNL.43.5.1045] [PMID: 8492925]
[http://dx.doi.org/10.1212/WNL.47.5.1331] [PMID: 8909454]
[http://dx.doi.org/10.1002/(SICI)1097-4598(199812)21:12<1701:AID-MUS12>3.0.CO;2-K] [PMID: 9843072]
[http://dx.doi.org/10.1002/mds.870090604] [PMID: 7845399]
[http://dx.doi.org/10.1159/000117196] [PMID: 8719647]
[http://dx.doi.org/10.1002/mds.870110306] [PMID: 8723140]
[http://dx.doi.org/10.1001/archneur.1996.00550070055012] [PMID: 8929169]
[http://dx.doi.org/10.1007/s100720070049] [PMID: 11441571]
[http://dx.doi.org/10.1212/WNL.56.11.1523] [PMID: 11402109]
[http://dx.doi.org/10.1371/journal.pone.0153739] [PMID: 27101283]
[http://dx.doi.org/10.1371/journal.pone.0178670] [PMID: 28586370]
[http://dx.doi.org/10.1017/cjn.2017.260] [PMID: 29157315]
[http://dx.doi.org/10.1016/j.parkreldis.2018.06.019] [PMID: 29929813]
[http://dx.doi.org/10.3390/toxins10070299]
[http://dx.doi.org/10.3390/toxins11020125]
[http://dx.doi.org/10.1212/WNL.45.4.822] [PMID: 7723978]
[http://dx.doi.org/10.1002/mds.870120516] [PMID: 9380055]
[http://dx.doi.org/10.1097/00005537-200008000-00028] [PMID: 10942143]
[http://dx.doi.org/10.1177/000348940010900216] [PMID: 10685574]
[http://dx.doi.org/10.1001/archneur.61.9.1416] [PMID: 15364688]
[http://dx.doi.org/10.1002/lary.25485] [PMID: 26198384]
[http://dx.doi.org/10.1002/lary.26911] [PMID: 28988441]
[http://dx.doi.org/10.6061/clinics/2018/e87] [PMID: 30020342]
[http://dx.doi.org/10.1177/088307389300800208] [PMID: 8505478]
[http://dx.doi.org/10.1002/mds.870130516] [PMID: 9756157]
[http://dx.doi.org/10.1002/mds.20878] [PMID: 16602105]
[http://dx.doi.org/10.1002/mds.1132] [PMID: 11481715]
[http://dx.doi.org/10.1007/s00415-006-0039-9] [PMID: 16845571]
[http://dx.doi.org/10.1111/cns.12692] [PMID: 28371468]
[http://dx.doi.org/10.1016/0022-510X(95)00128-O] [PMID: 8543937]
[http://dx.doi.org/10.1111/j.1365-2125.1997.tb00044.x] [PMID: 9056064]
[http://dx.doi.org/10.1016/j.ejphar.2012.08.014] [PMID: 22975288]
[http://dx.doi.org/10.1016/j.neuropharm.2011.05.015] [PMID: 21640732]
[http://dx.doi.org/10.1016/j.neulet.2015.01.078] [PMID: 25643620]
[http://dx.doi.org/10.1097/WNF.0b013e3181ebd109] [PMID: 20838216]
[http://dx.doi.org/10.1212/WNL.53.5.1154-a] [PMID: 10496290]
[http://dx.doi.org/10.1002/mds.10371] [PMID: 12722174]
[PMID: 19412450]
[http://dx.doi.org/10.1097/00002826-198904000-00009] [PMID: 2655897]
[http://dx.doi.org/10.1001/jama.1986.03380190045017] [PMID: 3773169]
[PMID: 3296121]
[http://dx.doi.org/10.1136/jnnp.53.3.268-a] [PMID: 2182784]
[http://dx.doi.org/10.1111/j.1600-0404.1989.tb03804.x] [PMID: 2741669]
[http://dx.doi.org/10.1016/S0140-6736(71)92340-3]
[PMID: 318090]
[http://dx.doi.org/10.1007/BF00314043] [PMID: 3998775]
[PMID: 9131917]
[PMID: 12768510]
[http://dx.doi.org/10.1002/mds.870010403] [PMID: 3332805]
[http://dx.doi.org/10.1136/jnnp.44.12.1171] [PMID: 6460852]
[http://dx.doi.org/10.1136/jnnp.49.2.222-a] [PMID: 3950649]
[http://dx.doi.org/10.1002/mds.20605] [PMID: 15986420]
[http://dx.doi.org/10.1212/01.wnl.0000188670.38576.bd] [PMID: 16382538]
[http://dx.doi.org/10.1002/mds.870040110] [PMID: 2927403]
[PMID: 1526217]
[PMID: 1917560]
[http://dx.doi.org/10.1136/bcr-2017-223945]
[http://dx.doi.org/10.1001/archneur.1987.00520210007009] [PMID: 3619708]
[http://dx.doi.org/10.1111/j.1600-0404.1983.tb04833.x] [PMID: 6362317]
[http://dx.doi.org/10.1002/mds.870060310] [PMID: 1681430]
[http://dx.doi.org/10.1136/jnnp.49.2.198] [PMID: 3512778]
[http://dx.doi.org/10.1212/01.wnl.0000218297.90054.28] [PMID: 16769957]
[http://dx.doi.org/10.1016/S0304-3940(01)02166-8] [PMID: 11595339]
[http://dx.doi.org/10.1021/acs.jmedchem.7b00846] [PMID: 28753313]
[http://dx.doi.org/10.1016/j.wneu.2017.05.112] [PMID: 28559069]
[http://dx.doi.org/10.1016/j.neulet.2019.04.017] [PMID: 30974232]
[http://dx.doi.org/10.1016/j.neulet.2017.06.015] [PMID: 28627375]
[http://dx.doi.org/10.1080/01616412.2016.1275456] [PMID: 28095756]
[http://dx.doi.org/10.1111/bph.13581] [PMID: 27545646]
[http://dx.doi.org/10.1517/14728222.2015.1028360] [PMID: 25862159]