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Review
. 2022 May 24;9(5):676-687.
doi: 10.1002/mdc3.13463. eCollection 2022 Jul.

Medical and Surgical Treatment for Medication-Induced Tremor: Case Report and Systematic Review

Wardell E Amerika  1 , Saskia van der Gaag  1 , Arne Mosch  1 , Niels A van der Gaag  1 , Carel F E Hoffmann  1 , Rodi Zutt  1 , Johan Marinus  2 , Maria Fiorella Contarino  1   2
Affiliations
Review

Medical and Surgical Treatment for Medication-Induced Tremor: Case Report and Systematic Review

Wardell E Amerika et al. Mov Disord Clin Pract. .

Abstract

Objective: To present a case of refractory medication-induced tremor successfully treated with deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (Vim) and to propose a medical and surgical treatment algorithm based on a systematical review of the literature.

Methods: Patient data were retrospectively collected. A systematic search was performed in PubMed, Embase, and Cochrane Library. Subjective and objective data were pooled for analysis by classifying them into 5 predefined categories(no, minimal, moderate, good, and excellent effects).

Results: The patient presented with lithium-induced bilateral progressive hand tremor lasting 25 years. After DBS, he reported excellent tremor suppression until the last follow-up (36 months after Vim-DBS). For the review, 34 of 140 studies were included and evaluated (178 unique subjects, 31 different treatments). A good-to-excellent tremor suppression (50%-100%) in at least 50% of subjects was achieved using propranolol (12 studies, 50% of 56 subjects), tetrabenazine (5 studies, 51% of 13 subjects), and metoprolol (4 studies, 75% of 8 subjects). The effect of benztropine and diphenhydramine was none or only minimal to moderate (up to 50% improvement; both: 3 studies, 50% of 4 patients). One article reported minimal-to-moderate effectiveness after DBS of the ventral oral posterior nucleus of the thalamus. Methods were highly heterogeneous. All studies scored grade III or IV quality of evidence, which was insufficient for recommendations (level U).

Conclusion: Treatment decision making should be performed on a case-by-case basis considering the low level of evidence, and we propose a practically oriented treatment algorithm. Propranolol, tetrabenazine, and metoprolol might be effective. For selected and refractory cases, DBS might be considered.

Keywords: deep brain stimulation; medical treatment; medication‐induced tremor; tardive tremor; thalamus.

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Conflict of interest statement

The authors declare no funding sources or conflicts of interest.

Figures

FIG. 1
FIG. 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flowchart of study selection in systematic review.
FIG. 2
FIG. 2
Effectiveness of most investigated drugs, for which at least 3 articles were available. The investigated drugs are shown on the y‐axis, and the amount of studies pertaining a particular result are shown on the x‐axis. Effects are divided in 3 groups: good to excellent, minimal to moderate, and no effect. The numbers at the end of each bar represent the number of subjects. A red border indicates the inclusion of 1or more level III quality studies.
FIG. 3
FIG. 3
Suggested flowchart for the treatment of medication‐induced tremor. The steps suggesting deep brain stimulation (DBS) or use of other medications are marked as “consider to” because of the scanty of available evidence. *Nadolol, acetazolamide, donepezil, potassium, pregabalin, primidone, sotalol, or vitamin B6.
See this image and copyright information in PMC

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