Grobe-Einsler Marcus, Kaut Oliver
Department of Neurology, University Clinic Bonn, Venusberg-Campus 1, 53105 Bonn, Germany.
German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
Neurol Res Pract. 2020 Jan 29;2:3. doi: 10.1186/s42466-020-0050-0. eCollection 2020.
Management of primary orthostatic tremor (POT) remains challenging, and medication is often ineffective. We report the case of a 53-year-old female with orthostatic tremor for 6 years who was refractory to gabapentin, clonazepam, primidone and propranolol. After treatment with 4 mg/day perampanel, she reported almost complete resolution of tremor. The diagnosis of POT was confirmed by tremor analysis using surface electromyography. Our report shows the potential use of the novel AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist perampanel for the treatment of POT. To date, only two similar patients, one refractory to treatment and the other previously treated with clonazepam only, have been reported. We would like to note that our patient was refractory to all previous therapy and responded to a low dose of perampanel without side effects. The striking clinical improvement suggests a putative role of glutamate in the pathophysiology of orthostatic tremor.
原发性直立性震颤（POT）的治疗仍然具有挑战性，药物治疗往往无效。我们报告了一例53岁女性，患有直立性震颤6年，对加巴喷丁、氯硝西泮、扑米酮和普萘洛尔均无效。在用4毫克/天的吡仑帕奈治疗后，她报告震颤几乎完全消失。通过表面肌电图进行震颤分析确诊为POT。我们的报告显示了新型AMPA（α-氨基-3-羟基-5-甲基-4-异恶唑丙酸）受体拮抗剂吡仑帕奈治疗POT的潜在用途。迄今为止，仅报告了两例类似患者，一例治疗无效，另一例仅先前接受过氯硝西泮治疗。我们想指出的是，我们的患者对之前所有治疗均无效，而对低剂量的吡仑帕奈有反应且无副作用。显著的临床改善表明谷氨酸在直立性震颤的病理生理学中可能起作用。
