[jhPF@hampshire.edu]

My 87 yo mother got immediate relief from
Mysoline but got so dizzy, weak & nauseaus that she
cannot take this med.

Do you know any equivelent anti-convulsant for the
elderly ?

she has been on Ativan too which relieves tremors but
makes her low energy and slow acting.

thanks

[bkdaniels]

Hey jhPF@hampshire.edu, how are you doing?

In a small, open-label case series, mirtazapine was reported to reduce tremor in patients with ET and Parkinson disease (PD). Currently the authors often try mirtazapine as a second-line agent.

Essential tremor (ET) is the most common movement disorder. It is a syndrome characterized by a slowly progressive postural and/or kinetic tremor, usually affecting both upper extremities.

For patients who do not achieve an adequate response with primidone and propranolol (active metabolites are phenylethylmalonamide (PEMA) and phenobarbital), the authors try the antidepressant mirtazapine. Clozapine, an atypical neuroleptic, has been shown to be effective in a randomized, double-blind, crossover study of patients who had definite or probable ET and poor response to propranolol or primidone.

Adverse effects, if any, usually occur early in the course of treatment with Primidone, possibly with the first dose. Acute adverse effects are minimized by starting at a low dose and slowly increasing the dose.

A suspension is available that allows even more gradual introduction. However, some patients are unable to tolerate primidone even at very low doses.

REFERENCE
Deborah Burke, MD,: Essential Tremor
Consulting Staff, Department of Neurology,
Largo Diagnostic Clinic

Gorman WP, Cooper R, Pocock P: A comparison or primidone, propranolol, and placebo in essential tremor, using quantitive analysis.
J Neurol Neurosurg Psychiatry 1986 Jan; 49(1): 64-8.

Best wishes,

"Experience is the best teacher, but has the toughest Grades module"
Byron K. Daniels, PBT