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本態性振戦の治療アルゴリズム

海外のエビデンスに基づいた治療アルゴリズムに、わが国における第1選択薬であるアロチノロールを追加している。アロチノロールは、日本人を対象として臨床試験された薬剤であり、わが国における至適用量が明らかである。保険適用もあり、保険診療に基づく第1選択薬として推奨される。
出典
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1: Essential tremor: treatment options.
著者: William G Ondo
雑誌名: Curr Treat Options Neurol. 2006 May;8(3):256-67.
Abstract/Text: The treatment of essential tremor depends on the tremor severity, location, and risk benefit ratios. Mild to moderate tremor usually will respond to oral agents such as noncardiac selective beta-blockers or primidone. Other agents including ethanol, topiramate, benzodiazepines, gabapentin, levetiracetam, and zonisamide may be effective. There are very little data comparing different oral agents, but there is support for polypharmacy in some cases. Botulinum toxin injections are effective in some tremor patterns, especially wrist flexion/extension and head tremor. For severe tremor, surgical lesioning or deep brain stimulation of the thalamus is justified and often dramatically improves function.
Curr Treat Options Neurol. 2006 May;8(3):256-67.

推奨されない薬剤(against use)

海外のエビデンスに基づき作成された「推奨されない薬剤」の表である。
出典
imgimg
1: Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology.
著者: T A Zesiewicz, R Elble, E D Louis, R A Hauser, K L Sullivan, R B Dewey, W G Ondo, G S Gronseth, W J Weiner, Quality Standards Subcommittee of the American Academy of Neurology
雑誌名: Neurology. 2005 Jun 28;64(12):2008-20. doi: 10.1212/01.WNL.0000163769.28552.CD. Epub 2005 Jun 22.
Abstract/Text: BACKGROUND: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use.
METHODS: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence.
RESULTS AND CONCLUSIONS: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.
Neurology. 2005 Jun 28;64(12):2008-20. doi: 10.1212/01.WNL.0000163769....

本態性振戦の治療アルゴリズム

海外のエビデンスに基づいた治療アルゴリズムに、わが国における第1選択薬であるアロチノロールを追加している。アロチノロールは、日本人を対象として臨床試験された薬剤であり、わが国における至適用量が明らかである。保険適用もあり、保険診療に基づく第1選択薬として推奨される。
出典
imgimg
1: Essential tremor: treatment options.
著者: William G Ondo
雑誌名: Curr Treat Options Neurol. 2006 May;8(3):256-67.
Abstract/Text: The treatment of essential tremor depends on the tremor severity, location, and risk benefit ratios. Mild to moderate tremor usually will respond to oral agents such as noncardiac selective beta-blockers or primidone. Other agents including ethanol, topiramate, benzodiazepines, gabapentin, levetiracetam, and zonisamide may be effective. There are very little data comparing different oral agents, but there is support for polypharmacy in some cases. Botulinum toxin injections are effective in some tremor patterns, especially wrist flexion/extension and head tremor. For severe tremor, surgical lesioning or deep brain stimulation of the thalamus is justified and often dramatically improves function.
Curr Treat Options Neurol. 2006 May;8(3):256-67.

推奨されない薬剤(against use)

海外のエビデンスに基づき作成された「推奨されない薬剤」の表である。
出典
imgimg
1: Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology.
著者: T A Zesiewicz, R Elble, E D Louis, R A Hauser, K L Sullivan, R B Dewey, W G Ondo, G S Gronseth, W J Weiner, Quality Standards Subcommittee of the American Academy of Neurology
雑誌名: Neurology. 2005 Jun 28;64(12):2008-20. doi: 10.1212/01.WNL.0000163769.28552.CD. Epub 2005 Jun 22.
Abstract/Text: BACKGROUND: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use.
METHODS: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence.
RESULTS AND CONCLUSIONS: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.
Neurology. 2005 Jun 28;64(12):2008-20. doi: 10.1212/01.WNL.0000163769....