PMID- 28409827
OWN - NLM
STAT- MEDLINE
DCOM- 20170801
LR  - 20240104
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 4
IP  - 4
DP  - 2017 Apr 14
TI  - Topiramate for essential tremor.
PG  - CD009683
LID - 10.1002/14651858.CD009683.pub2 [doi]
LID - CD009683
AB  - BACKGROUND: Essential tremor (ET) is one of the most common movement disorders. 
      The management is primarily based on pharmacological agents and in clinical 
      practice propranolol and primidone are considered the first-line therapy. 
      However, these treatments can be ineffective in 25% to 55% of people and are 
      frequently associated with serious adverse events (AEs). For these reasons, it is 
      worthwhile evaluating other treatments for ET. Topiramate has been suggested as a 
      potentially useful agent for the treatment of ET but there is uncertainty about 
      its efficacy and safety. OBJECTIVES: To assess the efficacy and safety of 
      topiramate in the treatment of ET. SEARCH METHODS: We carried out a systematic 
      search without language restrictions to identify all relevant trials in the 
      Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 
      to January 2017), Embase (January 1988 to January 2017), National Institute for 
      Health and Care Excellence (1999 to January 2017), ClinicalTrials.gov (1997 to 
      January 2017) and World Health Organization International Clinical Trials 
      Registry Platform (ICTRP; 2004 to January 2017). We searched BIOSIS Citation 
      Index (2000 to January 2017) for conference proceedings. We handsearched grey 
      literature and the reference lists of identified studies and reviews. SELECTION 
      CRITERIA: We included all randomised controlled trials (RCTs) of topiramate 
      versus placebo/open control or any other treatments. We included studies in which 
      the diagnosis of ET was made according to accepted and validated diagnostic 
      criteria. We excluded studies conducted in people presenting with secondary forms 
      of tremor or reporting only neurophysiological parameters to assess outcomes. 
      DATA COLLECTION AND ANALYSIS: Two review authors independently collected and 
      extracted data using a data collection form. We assessed the risk of bias and the 
      quality of evidence. We used a fixed-effect meta-analysis for data synthesis. 
      MAIN RESULTS: This review included three trials comparing topiramate to placebo 
      (309 participants). They were all at high overall risk of bias. The quality of 
      evidence ranged from very low to low. Compared to placebo, participants treated 
      with topiramate showed a significant improvement in functional disability and an 
      increased risk of withdrawal (risk ratio (RR) 1.78, 95% confidence interval (CI) 
      1.23 to 2.60). There were more AEs for topiramate-treated participants, 
      particularly paraesthesia, weight loss, appetite decrease and memory difficulty. 
      AUTHORS' CONCLUSIONS: This systematic review highlighted the presence of limited 
      data and very low to low quality evidence to support the apparent efficacy and 
      the occurrence of treatment-limiting AEs in people with ET treated with 
      topiramate. Further research to assess topiramate efficacy and safety on ET is 
      needed.
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
AD  - Department GF Ingrassia, Section of Neurosciences, University of Catania, 
      Catania, Italy, 95123.
FAU - Quattrocchi, Graziella
AU  - Quattrocchi G
AD  - Department GF Ingrassia, Section of Neurosciences, University of Catania, 
      Catania, Italy, 95123.
FAU - Allegra, Roberta
AU  - Allegra R
AD  - Department of Neurological Sciences, Policlinico Universitario G. Martino 
      Messina, Via Consolare Valeria, Messina, Italy, 90100.
FAU - Filippini, Graziella
AU  - Filippini G
AD  - Scientific Direction, Fondazione IRCCS, Istituto Neurologico Carlo Besta, via 
      Celoria, 11, Milan, Italy, 20133.
FAU - Colosimo, Carlo
AU  - Colosimo C
AD  - Department of Neurology, Terni University Hospital, Terni, Italy, 05100.
FAU - Zappia, Mario
AU  - Zappia M
AD  - Department GF Ingrassia, Section of Neurosciences, University of Catania, 
      Catania, Italy, 95123.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170414
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticonvulsants)
RN  - 0H73WJJ391 (Topiramate)
RN  - 30237-26-4 (Fructose)
SB  - IM
UOF - doi: 10.1002/14651858.CD009683
MH  - Activities of Daily Living
MH  - Anticonvulsants/adverse effects/*therapeutic use
MH  - Essential Tremor/*drug therapy
MH  - Fructose/adverse effects/*analogs & derivatives/therapeutic use
MH  - Humans
MH  - Patient Dropouts/statistics & numerical data
MH  - Publication Bias
MH  - Randomized Controlled Trials as Topic
MH  - Topiramate
PMC - PMC6478240
COIS- EB: none. AN: none. GQ: none. RA: none. GF: none. CC: none. MZ: none.
EDAT- 2017/04/15 06:00
MHDA- 2017/08/02 06:00
PMCR- 2018/04/14
CRDT- 2017/04/15 06:00
PHST- 2017/04/15 06:00 [pubmed]
PHST- 2017/08/02 06:00 [medline]
PHST- 2017/04/15 06:00 [entrez]
PHST- 2018/04/14 00:00 [pmc-release]
AID - CD009683.pub2 [pii]
AID - 10.1002/14651858.CD009683.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2017 Apr 14;4(4):CD009683. doi: 
      10.1002/14651858.CD009683.pub2.