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Prospective, longitudinal analysis of medication use in a cohort of elderly essential tremor cases


Background

There are no prospective, longitudinal studies investigating patterns of medication
use among essential tremor (ET) patients. Our goal was to fill this knowledge gap.
We also had a unique opportunity to examine medication use patterns primarily among
elders with longstanding ET. We hypothesized that by the time ET patients reach advanced
ages, medication changes would be uncommon – that is, they may have reached some kind
of equipoise.

Methods

A prospective, longitudinal cohort of ET cases was evaluated across three time points.
Cases were not ascertained from a treatment setting, thereby removing important selection
biases. Each reported current medications and dosages of each.

Results

There were 144 cases (mean baseline age = 76.1 ± 9.4 years). The mean observation
period = 2.9 ± 0.2 years. Primidone and propranolol were the most commonly used medications,
although almost one-half of cases (44.4%) reported using neither during this period.
A third of primidone users (33.3%) and a quarter of propranolol users (24.6%) reported
changes in use vs. nonuse during the observation period. The majority of our cases
made some change in their daily medication dosage during the course of the study –
73.3% of primidone users and 57.9% of propranolol users.

Conclusion

In this prospective, longitudinal study, use vs. nonuse and daily dosage of both primidone
and propranolol fluctuated across time for a sizable proportion of ET cases. Even
among elders with chronic, longstanding ET, there is considerable ongoing medication
adjustment, underscoring the need to improve the medication situation for ET patients.



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