Sunday, 29 July 2012

Primidone for MS tremor

Epub: Naderi et al. The Efficacy of Primidone in Reducing Severe Cerebellar Tremors in Patients With Multiple Sclerosis. Clin Neuropharmacol. 2012 Jul 19.

OBJECTIVES: Cerebellar tremor is a very disabling sign of MS, and various kinds of treatments have been proposed with different results. Primidone is one of the medications, mostly advised for essential tremor. The aim of our study was to determine the tolerability and efficacy of primidone in reducing severe cerebellar tremor in MSers.

METHODS: Ten MSers with severe cerebellar tremor were enrolled in this study. Primidone started with dose of 31.5 mg and gradually increased up to maximum of 750 mg/d. The severity of tremor was assessed with Activity of Daily Living (ADL), Nine-Hole Peg Test (NHPT), and Fahn Tremor Rating Scale (FTRS) at baseline and 2 follow-up studies after 6 and 12 weeks.

RESULTS: All outcome measures including ADL, FTRS, and NHPT of dominant and nondominant hands improved. The mean ADL changed from 51.8 at baseline to 36.8 after 12 weeks. FTRS was 14.8 at baseline, which reduced to 9.5 during this period. These changes were statistically significant. Although the time of the NHPT showed some improvement, it did not reach a statistically significant point after 6 weeks.The drug was well tolerated in all patients, and mild drowsiness reported by the patients disappeared at the end of the study.

CONCLUSIONS: Our study showed that primidone is tolerable in MS patients and effectively reduces severe cerebellar tremor in such MSers.


 "What is the problem with this study?"

"If you are are regular reader of this blog you will know that to assess whether or a treatment works or not you,to remover bias and to overcome the placebo effect you need to randomised, double-blind controlled trials. So these results are promising but not very convincing. As with most symptomatic therapies it would be interesting to know the proportion of responders vs. non-responders and whether or not a controlled withdrawwal resulted in a worsening of symptoms."


"I use primidone, which comes from the classs of drugs called the barbiturates. It is mainly used as an anti-convulsant to treat epilepsy. It is not used much because of  it causes excessive sedation and cognitive slowing. Most MSers find these symptoms a problem. Wouldn't you?"

"The following educational video from the NMSS covers tremor." 

  
Additional reading: primidone


4 comments:

  1. 'excessive sedation and cognitive slowing'
    - not worth it, unless it's possible to time the dose so that these effects happen when you sleep but the tremor reduction happens all day

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  2. Re: "not worth it, unless it's possible to time the dose so that these effects happen when you sleep but the tremor reduction happens all day"

    Unfortunately not, the effects on tremor are linked to action of the drug and the side effect of sedation. The drug builds up in the body with a long half-life so there is no obvious wearing off of the effects at night!

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  3. my md just started me on this drug and it sucks...my already feeling fatigued but able to somewhat function went to feeling like i could barely keep my eyes open. I took it 2 days ago and slept for most of those 2 days. I refused to take it yesterday when it was due to be taken because I was still feeling extremely groggy and hungover from the first dose. I would rather suffer the dysfunction of the tremors and the fatigue than to sleep my life away.

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    Replies
    1. Primidobe is metabolised into a barbiturate and is very sedating; this is another one of the "zombie drugs". It also affects cognition. I am not surprised you feel awful on it. We usually start at a very low dose and build up slowly; i.e. 62.5mg per day or a quarter of the 250mg tablet and if necessary lower than this. The dose is then built up over several months.

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