The American Academy of Neurology has developed practical treatment parameters for essential tremor( ET), which are based on modern scientific knowledge and practical experience. Treatment includes pharmacological (treatment with drugs such as Epitomax) and neurosurgical (deep stimulation of the basal ganglia) approach.
The most commonly used drugs for ET are beta-adrenergic receptor blockers (propranolol), Epitomax (topiramate), primidone, levetiracetam and gabapentin. At the same time, only propranolol, primidone and Epitomax (topiramate) are considered to be the first choice drugs in the treatment of patients with ET . Doses of all medications should be increased gradually and very slowly.
One of the main drugs for the treatment of patients with ET is Epitomax (topiramate). The Cochrane Review of the treatment of ET patients indicated that propranolol and primidone may be ineffective in 25-55% of ET patients and often have serious side effects, while Epitomax (topiramate) is proposed as a potentially useful drug for the treatment of ET patients. An analysis of three studies of a total of 309 patients showed a significant reduction in tremor and reduced functional disability in patients treated with Epitomax compared to those treated with placebo. Among the main side effects, paresthesia, loss of appetite, weight loss and memory impairment were noted.
There were significant clinical improvements in the use of Epitomax in low doses (100 mg / day), which reduces the risk of side effects. In some patients, such phenomena as a decrease in appetite and a decrease in body weight can be considered as positive effects of the drug. Epitomax should be used with caution in patients with angle-closure glaucoma and nephrolithiasis.
There was a statistically significant and clinically significant decrease in tremor in patients treated with Epitomax. At the same time, a relatively high frequency of side effects (paresthesia, nausea, drowsiness, fatigue, dyspepsia, loss of appetite with a decrease in body weight, psychomotor retardation) was noted when using this drug in high doses (300-400 mg/day). In this regard, it is recommended to use Epitomax in lower doses. Potential visual impairment in patients with angle-closure glaucoma has also been reported. Epitomax was usually prescribed 2 times a day. The initial dose was 25 mg / day, followed by an increase of 25-50 mg / week. In conclusion, it is indicated that Epitomax, apparently, is one of the most effective drugs for the treatment of ET, approaching the level of effectiveness of first-line therapy.
One case study demonstrated good efficacy of Epitomax in a patient with tremor resulting from an ischemic stroke.
In ET, the use of Epitomax in low and medium doses can be effective. Scheme of its application in ET:
Week 1: 25 mg in the evening;
Week 2: 25 mg morning and evening;
Week 3: 50 mg + 25 mg morning and evening;
from week 4: 50 mg + 50 mg in the morning and evening.
The maximum dose of Epitomax in ET is 300 mg/day. Do not increase the dose if a lower one is effective.
The advantage of the drug is its good tolerability when used in low doses compared to propranolol with long-term continuous administration. The most common side effects — drowsiness and nausea-usually pass quickly. Sometimes, with prolonged use, paresthesia and cognitive impairment can develop.