PMID- 26638213
OWN - NLM
STAT- MEDLINE
DCOM- 20160428
LR  - 20230303
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 2015
IP  - 12
DP  - 2015 Dec 6
TI  - Alprazolam for essential tremor.
PG  - CD009681
LID - 10.1002/14651858.CD009681.pub2 [doi]
LID - CD009681
AB  - BACKGROUND: Essential tremor (ET) is one of the most common movement disorders. 
      Treatment is based primarily on pharmacological agents. On this basis, although 
      primidone and propranolol are well-established treatments in clinical practice, 
      they could be ineffective in 25% to 55% of patients and can produce serious 
      adverse events (AEs) in a large percentage of individuals. For these reasons, 
      evaluating treatment alternatives for ET may be a worthwhile pursuit. Alprazolam 
      has been suggested as a potentially useful agent for treatment of individuals 
      with ET, but its efficacy and safety are uncertain. OBJECTIVES: PrimaryTo assess 
      the efficacy and safety of alprazolam in the treatment of individuals with ET. 
      SecondaryTo examine effects of alprazolam treatment on the quality of life of 
      people with ET. SEARCH METHODS: We carried out a systematic search without 
      language restrictions to identify all relevant trials. We searched the Cochrane 
      Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to 
      September 2015), EMBASE (January 1988 to September 2015), the National Institute 
      for Health and Care Excellence (NICE) (1999 to September 2015), 
      ClinicalTrials.gov (1997 to September 2015) and the World Health Organiza tion 
      (WHO) International Clinical Trials Registry Platform (ICTRP) (2004 to September 
      2015). We handsearched grey literature and examined the reference lists of 
      identified studies and reviews. SELECTION CRITERIA: We included all randomised 
      controlled trials (RCTs) of alprazolam versus placebo or any other treatment. We 
      included studies in which ET was diagnosed according to accepted and validated 
      diagnostic criteria. We excluded studies that included patients presenting with 
      secondary forms of tremor or reporting only neurophysiological parameters for the 
      pur p ose of assessing outcomes. DATA COLLECTION AND ANALYSIS: Two review authors 
      independently collected and extracted data using a data collection form. We 
      assessed risk of bias and the body of evidence. We used inverse variance methods 
      for continuous outcomes and measurement scales. We compared differences between 
      treatment groups as mean differences. We used Review Manager software for 
      management and analysis of data. MAIN RESULTS: We included in this review one 
      trial that compared alprazolam versus placebo (24 participants). It was judged to 
      have high overall risk of bias. We graded the overall quality of evidence as very 
      low. Compared with those given placebo, participants treated with alprazolam 
      showed a significant reduction in tremor severity (mean difference (MD) -0.75, 
      95% confidence interval (CI) -0.83 to -0.67). Nine alprazolam-treated 
      participants (75%) developed AEs, mainly represented by sedation (50%), 
      constipation (17%) and dry mouth (9%). No participants in the alprazolam group 
      and no p articipants in the placebo group discontinued treatment and dropped out 
      of the study. AUTHORS' CONCLUSIONS: Currently available data reveal evidence 
      insufficient for assessment of the efficacy and safety of alprazolam treatment 
      for individuals with ET.
FAU - Bruno, Elisa
AU  - Bruno E
AD  - Department GF Ingrassia,Section of Neurosciences, University of Catania, Catania, 
      Italy, 95123.
FAU - Nicoletti, Alessandra
AU  - Nicoletti A
FAU - Quattrocchi, Graziella
AU  - Quattrocchi G
FAU - Filippini, Graziella
AU  - Filippini G
FAU - Zappia, Mario
AU  - Zappia M
FAU - Colosimo, Carlo
AU  - Colosimo C
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20151206
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticonvulsants)
RN  - YU55MQ3IZY (Alprazolam)
SB  - IM
UOF - doi: 10.1002/14651858.CD009681
MH  - Adult
MH  - Aged
MH  - Alprazolam/adverse effects/*therapeutic use
MH  - Anticonvulsants/adverse effects/*therapeutic use
MH  - Constipation/chemically induced
MH  - Essential Tremor/*drug therapy
MH  - Humans
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - Xerostomia/chemically induced
PMC - PMC7387361
COIS- The original review was not compliant with Cochrane Commercial Sponsorship policy 
      for the following reasons: CC received financial support from Merz (manufacturer 
      of Botulinum toxin), Teva (manufacturer of propranolol) and other pharma 
      companies.
AN received financial support from Lundbeck (manufacturer of 
      benzodiazepine clobazam) and UCB (manufacturer of levetiracetam).
MZ received 
      financial support from Novartis (manufacturer of propranolol [Sandoz]), UCB, 
      Lundbeck and other pharma companies. Conversely, the current update have a 
      majority of authors and lead author free of conflicts as the lead author and all 
      the other authors have not received payments from manufacturers or marketers of 
      the interventions of interest or potential comparators within the 3 years of the 
      decision to update and none of the authors are/were employed by a company who has 
      a real or potential financial interest in the findings of the review and/or have 
      a relevant patent.
EDAT- 2015/12/08 06:00
MHDA- 2016/04/29 06:00
PMCR- 2016/12/06
CRDT- 2015/12/07 06:00
PHST- 2015/12/07 06:00 [entrez]
PHST- 2015/12/08 06:00 [pubmed]
PHST- 2016/04/29 06:00 [medline]
PHST- 2016/12/06 00:00 [pmc-release]
AID - CD009681.pub2 [pii]
AID - 10.1002/14651858.CD009681.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2015 Dec 6;2015(12):CD009681. doi: 
      10.1002/14651858.CD009681.pub2.