Short communicationSurvey of medication usage patterns among essential tremor patients: Movement disorder specialists vs. general neurologists☆
Introduction
Essential tremor (ET) is one of the most commonly-encountered movement disorders [1], [2], yet pharmacotherapeutic options are limited [3], [4]. There are only two front-line medications, propranolol and primidone. There is an anecdotal impression that only 50% of patients benefit from medications, although large surveys have not provided detailed treatment response data [5]. Aside from poor efficacy, bothersome side effects limit medication usage. Although small treatment trials (number of subjects = 11–22)[6], [7], [8], [9] have examined the efficacy of front-line medications during the brief clinical trial period, a more general appraisal of pharmacological management has not been undertaken. Interestingly, there has been no larger-scale survey of basic medication usage patterns in ET patients. What proportion of ET patients is treated with any medication? What proportion, with >1 medication? What is the average number of medications tried? What percentage has used a front-line medication at some point? What proportion has discontinued medication? To what extent does poor efficacy vs. intolerable side effects underlie these decisions? To address these questions, we reviewed the clinical experience of several hundred patients followed at our treatment center in New York. Two groups of patients, those followed by general neurologists and those followed by movement disorder neurologists, provided complementary data on treatment patterns.
Section snippets
Methods
The computerized billing database at the Neurological Institute of New York (NI), Columbia University Medical Center, was used to identify patients with the International Disease Classification (ICD)-9 diagnostic code 333.1 (essential and other specified forms of tremor). The search was open to both the Center for Parkinson’s Disease and Other Movement Disorders and the Division of General Neurology and was limited to patients seen ≥1 times within past five years by any of eight physicians.
Results
There were 260 ET patients; 37 (14.2%) were followed by general neurologists and 223 (85.8%), by movement disorder neurologists at our center (Table 1).
Discussion
We examined basic medication usage patterns across a large group of ET patients followed at our center. Patients cared for by general neurologists and those cared for by movement disorder neurologists provided contrasting data on treatment patterns. Among the latter, approximately three-quarters had taken at least one medication for ET and nearly one-third of these had had to test ≥4 medications in their attempt to obtain relief. For the patients who eventually underwent ET surgery, the mean
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The review of this paper was entirely handled by an Associate Editor, Robert Rodnitzky.