Reducing Tremors in MS

Primidone shown to be effective for treatment of MS tremors in small study

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Tremors are one of the most difficult multiple sclerosis (MS) symptoms to treat. Several medications exist to treat tremors, but not much is known about their ability to consistently reduce symptoms. This can be confusing for MS patients who experience tremors.

A recent small study published in the July issue of Clinical Neuropharmacology examined the tolerability and effectiveness of primidone in reducing severe cerebellar tremor in patients with MS.

The study showed the drug works to reduce MS symptoms and produces only mild tolerable drowsiness.

"Ask your doctor about new medications for MS symptoms"

Lead author Fereshteh Naderi, MD of the Sina MS Research Center and other researchers in Tehran, Iran, observed the use of primidone in ten MS patients who experienced severe cerebellar tremor for 12 weeks. Of the ten patients, eight were female and two were male, ranging in age from 14 to 46 years.

The participants were given 31.5 mg a day of primidone during the first week, which was gradually increased depending on tolerability to a maximum of 750 mg per day at six weeks.

Two out of the ten participants did not reach maximum dosage due to drowsiness and vertigo. The eight who did reach maximum dosage experienced mild drowsiness but the symptoms were not severe enough to stop drug escalation and disappeared by the end of the study.

Patients were evaluated for tremor severity using the Activity of Daily Living (ADL), NineHole Peg test (NHPT) and FahnTremor Rating Scale (FTRS) at the beginning of the study, at 6 weeks and at 12 weeks.

The ADL checklist refers to the basic tasks of everyday life, such as eating, bathing, dressing and using the toilet. The NHPT is the most objective and complex test for evaluation of tremor severity and the FTRS is a widely used instrument for rating the severity of tremors.

Use of primidone significantly improved NHPT when measured with the dominant hand, ADL and FTRS scores at 12 weeks.

This study suggests that starting primidone in small doses and then increasing over time is a good way to prevent adverse side effects.

There are limitations to the study. The study was done with a small sample size without a control group and does not address long-term effects or tolerability of the drug.

A randomized clinical trial is needed to further investigate how well primidone works to control tremors in MS patients.

The authors report no conflicts of interest for this study.

Reviewed by: 
Review Date: 
August 3, 2012
Last Updated:
August 6, 2012