Objective: This study aims to investigate the effectiveness and adverse effects of perampanel treatment for orthostatic tremor.

Background: Orthostatic tremor (OT) is a rare hyperkinetic movement disorder, characterized by a high-frequency tremor inducing ‘shaky legs’ upon standing. Patients with OT have a severely affected quality of life (QoL) [1]. Current prescribed medication (e.g. clonazepam and gabapentin) is often ineffective. A recent study by Gironell and co-authors, showed a possible potential for low dose perampanel in OT treatment [2].

Method: To assess the effectiveness and adverse effects of perampanel, a retrospective observational cohort study was performed. Patients from the Amsterdam UMC, location AMC who started perampanel treatment between November 2018 and March 2020 were included. Collected data included self-reported effect, QoL, and noted adverse effects.. QoL was assessed at baseline, i.e. before the start of perampanel, and at follow-up, i.e. when set on the most effective perampanel dose. To assess QoL four different self-report scales were used: the Hospital Anxiety and Depression Scale (HADS), the Short-Form Health Survey (SF-36), the instrumental Activities of Daily Living (iADL) and the Activities of Daily Living (ADL). Descriptive analyses were performed.

Results: A total of twenty-seven patients were treated with perampanel. Fifteen patients (55.6%) experienced a positive effect on OT complaints. Nine patients (33.3%) withdrew due to adverse effects and three patients (11.1%) since the treatment had no beneficial effect. In patients on perampanel, Depression Scores were lower and all SF-36 scores had improved at follow-up. The most reported adverse effects were dizziness (n=5), sleepiness (n=4), progression of tremor (n=3) , nightmares (n=2), tiredness (n=2), skin rash (n=2), and a blurry vision (n=2).

Conclusion: The current study shows a potential of perampanel in OT treatment and thereby confirms the findings of the study by Gironell and co-authors. This could be of great value since OT is such a rare and difficult-to-treat disease. Since the tolerance for perampanel proofs to be low, it is important to closely monitor effectiveness and adverse effects.

References: 1. Maugest, L., et al., Health-Related Quality of Life Is Severely Affected in Primary Orthostatic Tremor. Front Neurol, 2017. 8: p. 747. 2. Gironell, A. and J. Marin-Lahoz, Primary Orthostatic Tremor: Experience of Perampanel Use in 20 Patients. Tremor Other Hyperkinet Mov (N Y), 2019. 9.

« Back to MDS Virtual Congress 2021

MDS Abstracts - https://www.mdsabstracts.org/abstract/perampanel-as-a-treatment-for-orthostatic-tremor/