Objective: The purpose of this study is to examine the effect of age of onset on the selection of initial medication for symptomatic management of Essential tremor (ET).

Background: The age of onset in ET is variable. ET has a bimodal distribution of age at onset, with an early peak in the 20’s and another late-onset in the 60’s. A difference in clinical features, mode of progression, pathophysiology, co-morbidities, and mortality have been reported between the early and late-onset ET. The options for the pharmacological treatment of ET have not changed much over time. Factors influencing the choice of first line medication in ET are variable. This study was designed to determine if age of onset has a role in choice of initial medication in ET.

Method: Medical records of ET patients, seen in the Parkinson’s Disease Research, Education and Clinical Center (PADRECC), Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA, were reviewed. These patients were seen in the center from September 1, 2001 – March 31, 2018. Age groups were classified based on MDS tremor task group classification of age at onset [1]. Each record was reviewed to determine the initial medication used for the symptomatic management of ET.

Results: Profiles of 771 ET patients were reviewed. Primidone was used as the initial medication in 45% of adolescent age group(<20 years), 53% (n=48) of early adulthood age group (21-45 years), 50% (n=123) of middle age group (45-60 years), and 62% (n=149) of elderly age group (> 61 years) versus propranolol selection as initial medication was observed in 40% (n=43), 33% (n=60), 40% (n=97) and 33% (n=79) of age groups respectively. Topiramate was selected as the first line in 12% (n=13), 8% (n=15), 6% (n=14) and 2% (n=4) of the respective age groups.

Conclusion: In this chart review study, primidone was the most common medication prescribed in all age groups. Choice of topiramate as the initial medication declined with advancing age groups.

Figure 1

References: 1. Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, et al. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33(1):75-87

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MDS Abstracts - https://www.mdsabstracts.org/abstract/age-of-onset-and-choice-of-first-line-therapy-in-essential-tremor-patients/