Striano Pasquale, Coppola Antonietta, Vacca Giovanni, Zara Federico, Brescia Morra Vincenzo, Orefice Giuseppe, Striano Salvatore
Department of Neurological Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
J Neurol. 2006 Jun;253(6):762-6. doi: 10.1007/s00415-006-0112-4. Epub 2006 May 12.
Disabling tremor is frequent in multiple sclerosis (MS) and its treatment remains challenging. We conducted an open-label trial to evaluate the effect of levetiracetam (LEV) to treat cerebellar tremor in MS patients.
Fourteen MS patients, aged 27 to 57 years, with cerebellar tremor. Tremor duration ranged from 3 to 14 years. The tremor clinical rating scale, the spiral drawings scale, and ataxia clinical scale were used to assess the severity of tremor. Data about the tremor-induced disability were obtained by using the specific Activities of Daily Living Questionnaire (ADL). LEV was orally administered at a starting dose of 500 mg twice daily for one week followed by increments of 500 mg twice daily each week up to the target dose of 50 mg/Kg/day. Patients were evaluated at baseline and two weeks after the end of titration phase. The Wilcoxon matched-pairs test was used for statistical analysis.
Eleven patients completed the trial. LEV administration was associated with subjective and objective improvement of the tremor, with significant lowering of all tremor measurements' sum of scores as well as of ADL mean score between the baseline and follow-up. No correlation was found between the degree of improvement of the tremor and the disease duration or progression. LEV was well tolerated by subjects who completed the study.
LEV could be useful for the management of cerebellar tremor in MS and the good tolerability makes it easy to test. LEV long-term efficacy should be confirmed in extended studies.
在多发性硬化症（MS）中，致残性震颤很常见，其治疗仍然具有挑战性。我们进行了一项开放标签试验，以评估左乙拉西坦（LEV）治疗MS患者小脑震颤的效果。
14例年龄在27至57岁之间、患有小脑震颤的MS患者。震颤持续时间为3至14年。使用震颤临床评定量表、螺旋线图量表和共济失调临床量表来评估震颤的严重程度。通过使用特定的日常生活活动问卷（ADL）获得有关震颤导致的残疾的数据。LEV口服给药，起始剂量为500mg，每日两次，持续一周，随后每周增加500mg，每日两次，直至目标剂量50mg/Kg/天。在基线时以及滴定阶段结束后两周对患者进行评估。采用Wilcoxon配对检验进行统计分析。
11例患者完成了试验。服用LEV与震颤的主观和客观改善相关，在基线和随访之间，所有震颤测量得分总和以及ADL平均得分均显著降低。未发现震颤改善程度与疾病持续时间或进展之间存在相关性。完成研究的受试者对LEV耐受性良好。
LEV可能对MS患者小脑震颤的管理有用，良好的耐受性使其易于进行试验。LEV的长期疗效应在进一步的研究中得到证实。
