Primary Orthostatic Tremor: Experience of Perampanel Use in 20 Patients

  • Alexandre Gironell
  • Juan Marín-Lahoz


Background: Primary orthostatic tremor (POT) is a rare disorder for which current treatments are largely ineffective. Following up on our recent report of complete resolution of POT symptoms in a patient using low doses of perampanel, we describe our experience of perampanel in 20 patients.

Methods: Twenty patients whose neurologists prescribed perampanel were recruited. Initial dose was 2 mg/day, which was increased to 4 mg/day after the first month. Treatment efficacy was self-scored from +3 to −3 at 1 and 3 months.

Results: Eight patients withdrew due to adverse effects. Of the 12 patients who completed the study, 92% indicated that their POT symptoms had improved after 1 month, with 75% indicating moderate to marked improvement (mean score 1.9 ± 0.9). This improvement was not sustained by follow-up at 3 months (mean score 0.9 ± 1.3). A rebound of POT symptoms that lasted 2–6 weeks was observed in most patients who withdrew.

Discussion: Our experience with this series of cases points to the potential of low-dose perampanel as a treatment for POT, although poor tolerance and the possibility of a non-persistent therapeutic benefit need to be considered. Controlled studies are needed to confirm these findings.

Keywords: Orthostatic tremor, primary orthostatic tremor, tremor, perampanel, unsteadiness

Citation: Gironell A, Marín-Lahoz J. Primary orthostatic tremor: experience of perampanel use in 20 patients. Tremor Other Hyperkinet Mov. Tremor Other Hyperkinet Mov. 2019; 9. doi: 10.7916/tohm.v0.720