丙戊酸钠所致震颤的临床特征及诊治进展_Journal of Epilepsy

Authors：

胡美玲 ¹ ,  孙红斌 ²

1. ;
2. ;

Corresponding author：

孙红斌, Email: shb1369@aliyun.com

Keywords：

癫痫; 丙戊酸钠; 震颤; 盐酸阿罗洛尔

DOI：

10.7507/2096-0247.20190037

Video：

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丙戊酸钠（VPA）常见的神经系统不良反应是药源性震颤，所致震颤通常表现为快速、低振幅、对称性震颤，主要为上肢姿势性震颤。震颤的频率为 8～14 Hz，屈肌与伸肌的振幅为 100～400 uV。VPA 导致震颤机制主要为 γ-氨基丁酸、多巴胺、儿茶酚胺的改变，以及线粒体呼吸链的功能缺陷。加速度计、体表肌电图、临床震颤评估量表是目前常用的震颤评估方法。严重的震颤需进行干预，治疗应个体化，若患者的病情不允许减少 VPA 的剂量或者更换另一种抗癫痫药物，盐酸阿罗洛尔可作为治疗震颤的首选药物之一。若为药物难治性的震颤，可考虑手术治疗。文章旨在对 VPA 导致震颤的临床特征、相关机制及诊治进展进行综述，为相关疾病的临床诊治提供参考。

Citation： 胡美玲, 孙红斌. 丙戊酸钠所致震颤的临床特征及诊治进展. Journal of Epilepsy, 2019, 5(3): 205-208. doi: 10.7507/2096-0247.20190037 Copy

1.	Zhao M, Alleva R, Ma H, et al. Optogenetic tools for modulating and probing the epileptic network. Epilepsy Res, 2015, 116: 15-26.
2.	Perucca E. Pharmacological and therapeutic properties of valproate. CNS Drugs, 2002, 16(10): 695-714.
3.	Morgan JC, Kurek JA, Davis JL, et al. Insights into pathophysiology from medication-induced tremor. Tremor Other Hyperkinet Mov, 2017, 7: 442.
4.	Alonso-Juarez M, Baizabal-Carvallo JF. Distinguishing features between valproate-induced tremor and essential tremor. Acta Neurol Scand, 2018, 138(2): 177-181.
5.	Alonso-Juarez M, Torres-Russotto D, Crespo-Morfin P, et al. The clinical features and functional impact of valproate-induced tremor. Parkinsonism Relat Disord, 2017, 44: 147-150.
6.	Rinnerthaler M, Luef G, Mueller J, et al. Computerized tremor analysis of valproate-induced tremor: a comparative study of controlled-release versus conventional valproate. Epilepsia, 2005, 46(2): 320-323.
7.	Yu P, Zhu G, Wu X, et al. A 6-month prospective study on efficacy safety and QOL profiles of extended-release formulation of valproate in patients with epilepsy. Seizure, 2011, 20(1): 23-26.
8.	Mehndiratta MM, Satyawani M, Gupta S, et al. Clinical and surface EMG characteristics of valproate induced tremors. Electromyogr Clin Neurophysiol, 2005, 45(3): 177-182.
9.	Haubenberger D, Abbruzzese G, Bain PG, et al. Transducer-based evaluation of tremor. Mov Disord, 2016, 31(9): 1327-1336.
10.	Kanner AM, Balabanov A. Valproate: a practical review of its uses in neurological and psychiatric disorders. Expert Rev Neurother, 2002, 2(2): 151-165.
11.	Hamed SA, Abdellah MM. The relationship between valproate induced tremors and circulating neurotransmitters: a preliminary study. Int J Neurosci, 2017, 127(3): 236-242.
12.	Vamos E, Csati A, Vecsei L, et al. Effects of valproate on the dopaminergic system in mice. Neurol Res, 2009, 31(3): 217-219.
13.	LeWitt PA. Norepinephrine: the next therapeutics frontier for parkinson's disease. Transl Neurodegener, 2012, 1(1): 4.
14.	Dorszewska J, Prendecki M, Oczkowska A, et al. Polymorphism of the COMT, MAO, DAT, NET and 5-HTT genes, and biogenic amines in Parkinson's disease. Curr Genomics, 2013, 14(8): 518-533.
15.	Hamed SA, Elserogy YM, Abd-ElHafeez HA. Psychopathological and peripheral levels of neurobiological correlates of obsessive-compulsive symptoms in patients with epilepsy: a hospital-based study. Epilepsy Behav, 2013, 27(2): 409-415.
16.	Masmoudi K, Gras-Champel V, Bonnet I, et al. Dementia and extrapyramidal problems caused by long-term valproic acid. Therapie, 2000, 55(5): 629-634.
17.	Siniscalchi A, Gallelli L, Loizzo S, et al. Sodium valproate induced tremor in a patient with epilepsy and Down's syndrome. Curr Drug Saf, 2013, 8(1): 69-71.
18.	Bove F, Di Lazzaro G, Mulas D, et al. A role for accelerometry in the differential diagnosis of tremor syndromes. Funct Neurol, 2018, 33(1): 45.
19.	Alty J, Cosgrove J, Thorpe D, et al. How to use pen and paper tasks to aid tremor diagnosis in the clinic. , 2017, 17(6): 456-463.
20.	Fahn S, Tolosa E, Marín C. Clinical rating scale for tremor. Parkinson’s disease and movement disorders. Baltimore: Md Urban & Schwarzenberg, 1988: 225-234.
21.	Fahn S, Tolosa E, Marín C. Clinical rating scale for tremor. Parkinson’s disease and movement disorders. Baltimore: Md Urban & Schwarzenberg, 1993, 2: 271-280.
22.	Elble R, Bain P, João Forjaz M, et al. Task force report: scales for screening and evaluating tremor: critique and recommendations. Mov Disord, 2013, 28(13): 1793-1800.
23.	Elble RJ, Lyons KE, Pahwa R. Levetiracetam is not effective for essential tremor. Clin Neuropharmacol, 2007, 30(6): 350-356.
24.	Bain PG, Findley LJ, Atchison P, et al. Assessing tremor severity. J Neurol Neurosurg Psychiatry, 1993, 56(8): 868-873.
25.	He ZF, Chen J, Zhou CN, et al. Disabling tremor induced by long-term use of sodium valproate and lamotrigine: case report. Medicine, 2017, 96(47): e8711.
26.	Schneider SA, Deuschl G. The treatment of tremor. Neurotherapeutics, 2014, 11(1): 128-138.
27.	Zappia M, Albanese A, Bruno E, et al. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian movement disorders association. J Neurol, 2013, 260(3): 714-740.
28.	Lee KS, Kim JS, Kim JW, et al. A multicenter randomized crossover multiple-dose comparison study of arotinolol and propranolol in essential tremor. Parkinsonism Relat Disord, 2003, 9(6): 341-347.
29.	Lee DB, Woo YS, Bahk WM. Use of arotinolol pharmacotherapy to treat drug-induced tremor: a report of three cases. Pharmacopsychiatry, 2015, 48(4-5): 176-178.
30.	Louis ED, Hernandez N, Dyke JP, et al. Effect of primidone on dentate nucleus gamma-aminobutyric acid concentration in patients with essential tremor. Clin Neuropharmacol, 2016, 39(1): 24-28.
31.	Crosby NJ, Deane K, Clarke CE. Amantadine in parkinson's disease. Cochrane Database Syst Rev, 2003, (2): CD003467.
32.	Witjas-Slucki T. Surgical treatments for tremors. Revue Neurologique, 2018, 174(9): 615-620.
33.	Deuschl G, Raethjen J, Hellriegel H, et al. Treatment of patients with essential tremor. Lancet Neurol, 2011, 10(2): 148-161.
34.	Ravikumar VK, Parker JJ, Hornbeck TS, et al. Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Mov Disord, 2017, 32(8): 1165-1173.
35.	Martínez-Moreno NE, Sahgal A, De Salles A, et al. Stereotactic radiosurgery for tremor: systematic review: international stereotactic radiosurgery society practice guidelines. J Neuro Surg, 2018, 1: 1-12.
36.	Elias WJ, Lipsman N, Ondo WG, et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med, 2016, 375(8): 730-739.

1. Zhao M, Alleva R, Ma H, et al. Optogenetic tools for modulating and probing the epileptic network. Epilepsy Res, 2015, 116: 15-26.
2. Perucca E. Pharmacological and therapeutic properties of valproate. CNS Drugs, 2002, 16(10): 695-714.
3. Morgan JC, Kurek JA, Davis JL, et al. Insights into pathophysiology from medication-induced tremor. Tremor Other Hyperkinet Mov, 2017, 7: 442.
4. Alonso-Juarez M, Baizabal-Carvallo JF. Distinguishing features between valproate-induced tremor and essential tremor. Acta Neurol Scand, 2018, 138(2): 177-181.
5. Alonso-Juarez M, Torres-Russotto D, Crespo-Morfin P, et al. The clinical features and functional impact of valproate-induced tremor. Parkinsonism Relat Disord, 2017, 44: 147-150.
6. Rinnerthaler M, Luef G, Mueller J, et al. Computerized tremor analysis of valproate-induced tremor: a comparative study of controlled-release versus conventional valproate. Epilepsia, 2005, 46(2): 320-323.
7. Yu P, Zhu G, Wu X, et al. A 6-month prospective study on efficacy safety and QOL profiles of extended-release formulation of valproate in patients with epilepsy. Seizure, 2011, 20(1): 23-26.
8. Mehndiratta MM, Satyawani M, Gupta S, et al. Clinical and surface EMG characteristics of valproate induced tremors. Electromyogr Clin Neurophysiol, 2005, 45(3): 177-182.
9. Haubenberger D, Abbruzzese G, Bain PG, et al. Transducer-based evaluation of tremor. Mov Disord, 2016, 31(9): 1327-1336.
10. Kanner AM, Balabanov A. Valproate: a practical review of its uses in neurological and psychiatric disorders. Expert Rev Neurother, 2002, 2(2): 151-165.
11. Hamed SA, Abdellah MM. The relationship between valproate induced tremors and circulating neurotransmitters: a preliminary study. Int J Neurosci, 2017, 127(3): 236-242.
12. Vamos E, Csati A, Vecsei L, et al. Effects of valproate on the dopaminergic system in mice. Neurol Res, 2009, 31(3): 217-219.
13. LeWitt PA. Norepinephrine: the next therapeutics frontier for parkinson's disease. Transl Neurodegener, 2012, 1(1): 4.
14. Dorszewska J, Prendecki M, Oczkowska A, et al. Polymorphism of the COMT, MAO, DAT, NET and 5-HTT genes, and biogenic amines in Parkinson's disease. Curr Genomics, 2013, 14(8): 518-533.
15. Hamed SA, Elserogy YM, Abd-ElHafeez HA. Psychopathological and peripheral levels of neurobiological correlates of obsessive-compulsive symptoms in patients with epilepsy: a hospital-based study. Epilepsy Behav, 2013, 27(2): 409-415.
16. Masmoudi K, Gras-Champel V, Bonnet I, et al. Dementia and extrapyramidal problems caused by long-term valproic acid. Therapie, 2000, 55(5): 629-634.
17. Siniscalchi A, Gallelli L, Loizzo S, et al. Sodium valproate induced tremor in a patient with epilepsy and Down's syndrome. Curr Drug Saf, 2013, 8(1): 69-71.
18. Bove F, Di Lazzaro G, Mulas D, et al. A role for accelerometry in the differential diagnosis of tremor syndromes. Funct Neurol, 2018, 33(1): 45.
19. Alty J, Cosgrove J, Thorpe D, et al. How to use pen and paper tasks to aid tremor diagnosis in the clinic. , 2017, 17(6): 456-463.
20. Fahn S, Tolosa E, Marín C. Clinical rating scale for tremor. Parkinson’s disease and movement disorders. Baltimore: Md Urban & Schwarzenberg, 1988: 225-234.
21. Fahn S, Tolosa E, Marín C. Clinical rating scale for tremor. Parkinson’s disease and movement disorders. Baltimore: Md Urban & Schwarzenberg, 1993, 2: 271-280.
22. Elble R, Bain P, João Forjaz M, et al. Task force report: scales for screening and evaluating tremor: critique and recommendations. Mov Disord, 2013, 28(13): 1793-1800.
23. Elble RJ, Lyons KE, Pahwa R. Levetiracetam is not effective for essential tremor. Clin Neuropharmacol, 2007, 30(6): 350-356.
24. Bain PG, Findley LJ, Atchison P, et al. Assessing tremor severity. J Neurol Neurosurg Psychiatry, 1993, 56(8): 868-873.
25. He ZF, Chen J, Zhou CN, et al. Disabling tremor induced by long-term use of sodium valproate and lamotrigine: case report. Medicine, 2017, 96(47): e8711.
26. Schneider SA, Deuschl G. The treatment of tremor. Neurotherapeutics, 2014, 11(1): 128-138.
27. Zappia M, Albanese A, Bruno E, et al. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian movement disorders association. J Neurol, 2013, 260(3): 714-740.
28. Lee KS, Kim JS, Kim JW, et al. A multicenter randomized crossover multiple-dose comparison study of arotinolol and propranolol in essential tremor. Parkinsonism Relat Disord, 2003, 9(6): 341-347.
29. Lee DB, Woo YS, Bahk WM. Use of arotinolol pharmacotherapy to treat drug-induced tremor: a report of three cases. Pharmacopsychiatry, 2015, 48(4-5): 176-178.
30. Louis ED, Hernandez N, Dyke JP, et al. Effect of primidone on dentate nucleus gamma-aminobutyric acid concentration in patients with essential tremor. Clin Neuropharmacol, 2016, 39(1): 24-28.
31. Crosby NJ, Deane K, Clarke CE. Amantadine in parkinson's disease. Cochrane Database Syst Rev, 2003, (2): CD003467.
32. Witjas-Slucki T. Surgical treatments for tremors. Revue Neurologique, 2018, 174(9): 615-620.
33. Deuschl G, Raethjen J, Hellriegel H, et al. Treatment of patients with essential tremor. Lancet Neurol, 2011, 10(2): 148-161.
34. Ravikumar VK, Parker JJ, Hornbeck TS, et al. Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Mov Disord, 2017, 32(8): 1165-1173.
35. Martínez-Moreno NE, Sahgal A, De Salles A, et al. Stereotactic radiosurgery for tremor: systematic review: international stereotactic radiosurgery society practice guidelines. J Neuro Surg, 2018, 1: 1-12.
36. Elias WJ, Lipsman N, Ondo WG, et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med, 2016, 375(8): 730-739.

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