Louis Elan D
Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University New York, NY, USA.
Front Neurol. 2012 Jan 13;2:91. doi: 10.3389/fneur.2011.00091. eCollection 2011.
Essential tremor (ET) is one of the most common neurological diseases. Although a large number of medications have been tested, there are only two first-line medications, primidone and propranolol, which is a situation that has not changed in approximately 30 years. Several recent reviews have summarized the current pharmacotherapeutic options for ET and the approach to the management of ET patients. Yet there remain a number of important issues, both scientific and clinical, that have not been broached in the literature and that have therapeutic implications.
To introduce several clinical and scientific issues that have not formally entered the published literature on the treatment of ET.
In September 2011, materials for this article were gathered during a literature search of PubMed using the following terms: ET, clinical, clinical trial, treatment, medications, therapeutics. English-language articles were selected for further review.
The paper focuses on several topics that have received scant or no discussion in the published literature on ET therapeutics. These topics are as follows: the nature of the underlying disease pathophysiology, the presence of pathological heterogeneity, the complexity of cellular and neurochemical changes which may be underlying this disorder, the presence of clinical heterogeneity, the selection of treatment endpoints, the effects of diagnostic uncertainty, the presence of cognitive and psychiatric features in ET, the identification of possible modifiable risk factors, and the absence of any neuroprotective therapies.
The author has identified several topics that have received scant or no discussion in the published literature on ET therapeutics. Further discussion of the issues raised here may lead to improvements in clinical trial methodologies as well as facilitate the development of fresh approaches to pharmacotherapy.
特发性震颤（ET）是最常见的神经系统疾病之一。尽管已经对大量药物进行了测试，但仅有两种一线药物，即扑米酮和普萘洛尔，这种情况在大约30年里一直未变。最近的几篇综述总结了ET目前的药物治疗选择以及ET患者的管理方法。然而，在文献中仍有一些重要的科学和临床问题未被提及，且这些问题具有治疗意义。
介绍一些尚未正式进入已发表的ET治疗文献的临床和科学问题。
2011年9月，在PubMed上进行文献检索，使用以下术语收集本文资料：ET、临床、临床试验、治疗、药物、疗法。选择英文文章进行进一步综述。
本文重点关注了几个在已发表的ET治疗文献中很少或没有讨论过的主题。这些主题如下：潜在疾病病理生理学的本质、病理异质性的存在、可能是该疾病基础的细胞和神经化学变化的复杂性、临床异质性的存在、治疗终点的选择、诊断不确定性的影响、ET中认知和精神特征的存在、可能可改变的危险因素的识别以及缺乏任何神经保护疗法。
作者确定了几个在已发表的ET治疗文献中很少或没有讨论过的主题。对这里提出的问题进行进一步讨论可能会改进临床试验方法，并促进新的药物治疗方法的开发。
