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Prospective, longitudinal analysis of medication use in a cohort of elderly essential tremor cases

Published:August 23, 2022DOI:https://doi.org/10.1016/j.jns.2022.120387

      Highlights

      • There are no longitudinal studies of medication use patterns among ET patients.
      • A prospective, longitudinal cohort of ET cases was evaluated across 3 time points.
      • Use and daily dosage of medications fluctuated for a sizable number of cases.
      • Even in elders with chronic ET, there is considerable ongoing medication adjustment.

      Abstract

      Background

      There are no prospective, longitudinal studies investigating patterns of medication use among essential tremor (ET) patients. Our goal was to fill this knowledge gap. We also had a unique opportunity to examine medication use patterns primarily among elders with longstanding ET. We hypothesized that by the time ET patients reach advanced ages, medication changes would be uncommon – that is, they may have reached some kind of equipoise.

      Methods

      A prospective, longitudinal cohort of ET cases was evaluated across three time points. Cases were not ascertained from a treatment setting, thereby removing important selection biases. Each reported current medications and dosages of each.

      Results

      There were 144 cases (mean baseline age = 76.1 ± 9.4 years). The mean observation period = 2.9 ± 0.2 years. Primidone and propranolol were the most commonly used medications, although almost one-half of cases (44.4%) reported using neither during this period. A third of primidone users (33.3%) and a quarter of propranolol users (24.6%) reported changes in use vs. nonuse during the observation period. The majority of our cases made some change in their daily medication dosage during the course of the study - 73.3% of primidone users and 57.9% of propranolol users.

      Conclusion

      In this prospective, longitudinal study, use vs. nonuse and daily dosage of both primidone and propranolol fluctuated across time for a sizable proportion of ET cases. Even among elders with chronic, longstanding ET, there is considerable ongoing medication adjustment, underscoring the need to improve the medication situation for ET patients.

      Keywords

      Abbreviations:

      COGNET (Clinical-Pathological Study of Cognitive Impairment in Essential Tremor), ET (essential tremor), MCI (mild cognitive impairment), TTS (total tremor score), WHIGET (Washington Heights-Inwood Genetic Study of Essential Tremor)
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