Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Seizure. 2019 Mar;66:70-75. doi: 10.1016/j.seizure.2019.02.002. Epub 2019 Feb 7.
Tremor is frequently observed in patients with epilepsy (PWE), which is generally attributed to the side-effect of antiepileptic drugs (AEDs) particularly valproate (VPA) with largely unknown mechanisms. The study aimed to assess the clinical features and related factors of tremor in PWE with tremor.
PWE with tremor and a control group of age- and sex-matched PWE without tremor were enrolled. Detailed demographic and clinical information for each individual was recorded. PWE with tremor were evaluated by The Clinical Rating Scale for Tremor (CRST) and Tremor Related Activities of Daily Living (TRADL) questionnaire.
132 individuals were enrolled, which including sixty-six (36 males) PWE with tremor with mean age of 33 years and epilepsy duration of 12.5 years. Tremor was postural in all, with median duration of four and one year from diagnosis and AED treatment to the onset of tremor respectively. The upper limbs were predominantly affected. VPA had been used in 62 (93.9%) PWE with tremor compared to 31 (47.0%) PWE without tremor (P < 0.001). The total CRST score was significantly associated with epilepsy duration and maximum VPA dosage (B = 0.30, p < 0.001; B = 0.32, p = 0.013). Patients with VPA dosage over 17.05 mg/kg/d might be more vulnerable to develop tremor.
PWE with tremor were more frequently treated with VPA, however, tremor was mild in most without any functional impairment. Epilepsy duration and maximum VPA dosage were important factors of tremor severity, suggesting mechanisms underlying tremor in PWE may be an elaborate interplay of AEDs and disease itself.
癫痫患者（PWE）常出现震颤，通常归因于抗癫痫药物（AEDs）的副作用，特别是丙戊酸钠（VPA），但其机制尚不清楚。本研究旨在评估有震颤的 PWE 的震颤临床特征和相关因素。
纳入有震颤的 PWE 和年龄、性别匹配的无震颤的 PWE 对照组。记录每位个体的详细人口统计学和临床信息。通过震颤临床评定量表（CRST）和震颤日常生活活动量表（TRADL）问卷对有震颤的 PWE 进行评估。
共纳入 132 名患者，其中 66 名（36 名男性）有震颤的 PWE 的平均年龄为 33 岁，癫痫持续时间为 12.5 年。所有震颤均为姿势性震颤，从诊断和 AED 治疗到震颤发作的中位时间分别为 4 年和 1 年。上肢受累为主。有震颤的 PWE 中有 62 名（93.9%）使用过 VPA，而无震颤的 PWE 中有 31 名（47.0%）（P<0.001）。总 CRST 评分与癫痫持续时间和最大 VPA 剂量显著相关（B=0.30，p<0.001；B=0.32，p=0.013）。VPA 剂量超过 17.05mg/kg/d 的患者可能更容易出现震颤。
有震颤的 PWE 更常使用 VPA 治疗，但大多数患者的震颤程度较轻，无任何功能障碍。癫痫持续时间和最大 VPA 剂量是震颤严重程度的重要因素，提示 PWE 震颤的潜在机制可能是 AEDs 和疾病本身的复杂相互作用。
