More Studies Needed on Drug Treatments for Multiple Sclerosis Tremor

A systematic review of research investigating the pharmacologic treatment of tremor in adults with multiple sclerosis (MS) concluded not with solid recommendations but with a call for more high quality studies into the issue. Researchers published their study in Multiple Sclerosis and Related Disorders.

“None of the medications suggested for the treatment of MS tremor has been shown to have significant or consistent benefit in satisfactorily designed studies, despite uncontrolled case reports suggesting a positive effect,” wrote researchers from Isfahan University of Medical Sciences in Iran.

Among 26 English-language studies deemed eligible by the research team, 13 had a low risk of bias and were subsequently included for full review.

Injections of botulinum toxin A offered the most improvement for MS tremor in reports, but with the adverse effect of increased weakness, researchers wrote. The effect of isoniazid in the treatment of MS-related tremor was limited and accompanied by possible adverse effects including hepatotoxicity and gastrointestinal, dermatologic, and neuromuscular problems.

Meanwhile, the effects of cannabis-based medicines, single-dose 5-HT3 receptor antagonists, and the antiepileptic drug levetiracetam were inconsistent and/or inconclusive, according to the review.

“Concluding a certain clinical recommendation was limited due to the scarcity of evidence from controlled studies with large sample sizes,” researchers wrote. “Further well-designed comparative clinical trials with a large sample size can improve clinical management of tremor in patients with MS.”

Reference:
Pourmohammadi A, Riahi R, Hosseini SM, Adibi I. Pharmacological treatment of tremor in multiple sclerosis; a systematic review. Mult Scler Relat Disord. Published online ahead of print March 9, 2022. doi:10.1016/j.msard.2022.103722