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Valproate-induced rest tremor and parkinsonism

Acta Neurologica Belgica volume 121, pages 515–519 (2021)Cite this article

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Abstract

Tremor and parkinsonism are recognized side effects of valproate; however, the relationship between rest tremor and other signs of parkinsonism has not been addressed in patients taking valproate. We studied a cohort of 125 consecutive patients treated with valproate due to epilepsy or migraine, evaluated with the Fahn–Tolosa–Marin Tremor Rating Scale (FTM-TRS). A total of 14 (11.2%) patients had rest tremor (bilateral n = 10, unilateral n = 4). Patients with rest tremor had significant higher scores in the FTM-TRS (P < 0.001), but only one was diagnosed with parkinsonism. Patients may have valproate-induced parkinsonism or exacerbated motor features of Parkinson’s disease by valproate. The frequency of parkinsonism was 1.6% in this cohort and of 3% in the pooled data of 717 patients from previous reports. Rest tremor is observed in 11.2% of patients treated with valproate and is related to the burden of valproate-induced tremor, rather than the presence of parkinsonism.

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References

  1. Alonso-Juarez M, Torres-Russotto D, Crespo-Morfin P, Baizabal-Carvallo JF (2017) The clinical features and functional impact of valproate-induced tremor. Parkinsonism Relat Disord 44:147–150

    Article  Google Scholar 

  2. Stacy MA, Elble RJ, Ondo WG, Wu SC, Hulihan J (2007) TRS study group, assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin tremor rating scale in essential tremor. Mov Disord 22:833–838

    Article  Google Scholar 

  3. Cohen O, Pullman S, Jurewicz E, Watner D, Louis ED (2003) Rest tremor in patients with essential tremor: prevalence, clinical correlates, and electrophysiologic characteristics. Arch Neurol 60:405–410

    Article  Google Scholar 

  4. Alonso-Juarez M, Baizabal-Carvallo JF (2018) Distinguishing features between valproate-induced tremor and essential tremor. Acta Neurol Scand 138:177–181

    Article  CAS  Google Scholar 

  5. Morgan JC, Sethi KD (2005) Drug-induced tremors. Lancet Neurol 4:866–876

    Article  CAS  Google Scholar 

  6. Hamed SA, Abdellah MM (2017) The relationship between valproate induced tremors and circulating neurotransmitters: a preliminary study. Int J Neurosci 127(3):236–242

    Article  CAS  Google Scholar 

  7. Zadikoff C, Munhoz RP, Asante AN et al (2007) Movement disorders in patients taking anticonvulsants. J Neurol Neurosurg Psychiatry 78:147–151

    Article  CAS  Google Scholar 

  8. Ristić AJ, Vojvodić N, Janković S, Sindelić A, Sokić D (2006) The frequency of reversible parkinsonism and cognitive decline associated with valproate treatment: a study of 364 patients with different types of epilepsy. Epilepsia 47:2183–2185

    Article  Google Scholar 

  9. Armon C, Shin C, Miller P, Carwile S, Brown E, Edinger JD, Paul RG (1996) Reversible parkinsonism and cognitive impairment with chronic valproate use. Neurology 47:626–635

    Article  CAS  Google Scholar 

  10. Easterford K, Clough P, Kellett M, Fallon K, Duncan S (2004) Reversible parkinsonism with normal beta-CIT-SPECT in patients exposed to sodium valproate. Neurology 62:1435–1437

    Article  CAS  Google Scholar 

  11. Jamora D, Lim SH, Pan A, Tan L, Tan EK (2007) Valproate-induced parkinsonism in epilepsy patients. Mov Disord 22:130–133

    Article  Google Scholar 

  12. Silver M, Factor SA (2013) Valproic acid-induced parkinsonism: levodopa responsiveness with dyskinesia. Parkinsonism Relat Disord 19:758–760

    Article  Google Scholar 

  13. Onofrj M, Thomas A, Paci C (1998) Reversible parkinsonism induced by prolonged treatment with valproate. J Neurol 245:794–796

    Article  CAS  Google Scholar 

  14. Gale K (1986) Role of the substantia nigra in GABA-mediated anticonvulsant actions. Adv Neurol 44:343–364

    CAS  PubMed  Google Scholar 

  15. Tepper JM, Lee CR (2007) GABAergic control of substantia nigra dopaminergic neurons. Prog Brain Res 160:189–208

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Guanajuato, 20 de Enero, León, C.P. 37320, Guanajuato, Mexico

    José Fidel Baizabal-Carvallo

  2. National Polytechnic Institute, México, Mexico

    Marlene Alonso-Juarez

Authors
  1. José Fidel Baizabal-Carvallo
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  2. Marlene Alonso-Juarez
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Contributions

JFB: 1A, 1B, 1C, 3A, 3B. MA: 1B, 1C, 3A. [(1) Research project: A. conception, B. organization, C. execution. (2) Statistical analysis: A. design, B. execution, C. review and critique. (3) Manuscript: A. writing of the first draft, B. review and critique.]

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Correspondence to José Fidel Baizabal-Carvallo.

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Baizabal-Carvallo, J.F., Alonso-Juarez, M. Valproate-induced rest tremor and parkinsonism. Acta Neurol Belg 121, 515–519 (2021). https://doi.org/10.1007/s13760-019-01239-8

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  • DOI: https://doi.org/10.1007/s13760-019-01239-8

Keywords

  • Tremor
  • Drug-induced tremor
  • Valproate
  • Anticonvulsants
  • Parkinsonism