Essential tremor treated with topiramate: A case series

Objective: The authors evaluated a series of essential tremor (ET) patients treated with topiramate in a university-based movement disorders clinic. Design: A retrospective clinical review of patient cases in a naturalistic setting was employed. Subjects and Setting: Patients who were prescribed topiramate for ET were identified from clinic records. Patients were contacted by telephone to determine subjective improvement of tremor. Patients reporting improvement were invited to return for clinical evaluation. Outcome Measures: Patients drew the Archimedes Spiral and were asked about performance of activities of daily living at each office visit. These activities were evaluated using a 5-point Essential Tremor Scale (ETS). Results: Fourteen ET patients had been prescribed topiramate. The average age was 58 years and the average tremor duration was 17 years. The mean final topiramate dose was 105 mg/day (range: 25 to 400 mg/day). Eight of the 14 patients reported subjective tremor improvement with a mean dose of 128 mg/day (50 to 400 mg/day). Five of the patients were available for further evaluation. The average topiramate dose for the five patients was 175 mg/day (50 to 400 mg/day). The mean initial ETS score was 3.02 (2.5 to 3.5) for the patients; the final mean ETS score was 2.3 (1.75 to 3). The mean dose for the six patients who stated they did not respond to topiramate treatment was 75 mg/day (25 to 100 mg/day). One patient discontinued topiramate due to increased nervousness. Conclusions: Based on the 57% subjective response rate seen in our case series, topiramate may be a useful treatment for some patients with ET in a clinical practice.