Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
J Neurol Sci. 2022 Nov 15;442:120387. doi: 10.1016/j.jns.2022.120387. Epub 2022 Aug 24.
There are no prospective, longitudinal studies investigating patterns of medication use among essential tremor (ET) patients. Our goal was to fill this knowledge gap. We also had a unique opportunity to examine medication use patterns primarily among elders with longstanding ET. We hypothesized that by the time ET patients reach advanced ages, medication changes would be uncommon - that is, they may have reached some kind of equipoise.
A prospective, longitudinal cohort of ET cases was evaluated across three time points. Cases were not ascertained from a treatment setting, thereby removing important selection biases. Each reported current medications and dosages of each.
There were 144 cases (mean baseline age = 76.1 ± 9.4 years). The mean observation period = 2.9 ± 0.2 years. Primidone and propranolol were the most commonly used medications, although almost one-half of cases (44.4%) reported using neither during this period. A third of primidone users (33.3%) and a quarter of propranolol users (24.6%) reported changes in use vs. nonuse during the observation period. The majority of our cases made some change in their daily medication dosage during the course of the study - 73.3% of primidone users and 57.9% of propranolol users.
In this prospective, longitudinal study, use vs. nonuse and daily dosage of both primidone and propranolol fluctuated across time for a sizable proportion of ET cases. Even among elders with chronic, longstanding ET, there is considerable ongoing medication adjustment, underscoring the need to improve the medication situation for ET patients.
目前尚无针对原发性震颤（ET）患者药物使用模式的前瞻性纵向研究。我们的目标是填补这一知识空白。我们还有一个独特的机会主要检查长期患有 ET 的老年人的药物使用模式。我们假设，当 ET 患者达到高龄时，药物变化将不常见-也就是说，他们可能已经达到了某种平衡。
对三个时间点的 ET 病例进行前瞻性纵向队列评估。病例不是从治疗环境中确定的，从而消除了重要的选择偏倚。每个病例都报告了当前使用的药物以及每种药物的剂量。
共有 144 例（平均基线年龄为 76.1±9.4 岁）。平均观察期为 2.9±0.2 年。普里米酮和普萘洛尔是最常用的药物，尽管在此期间几乎有一半的病例（44.4％）未使用这两种药物。三分之一的普里米酮使用者（33.3％）和四分之一的普萘洛尔使用者（24.6％）报告在观察期间使用或未使用药物。在研究过程中，我们大多数病例的日常用药剂量都有所改变-73.3％的普里米酮使用者和 57.9％的普萘洛尔使用者。
在这项前瞻性纵向研究中，相当一部分 ET 病例的普里米酮和普萘洛尔的使用与否以及每日剂量在整个时间内都有波动。即使在患有慢性长期 ET 的老年人中，也需要进行大量的药物调整，这突显了改善 ET 患者药物治疗状况的必要性。
