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Updates in Tremor Treatments | Congress 2023

September 18, 2023
Series:MDS Congress 2023
What new research is coming that may change the way clinicians treat tremor? Dr. Tiago Mestre shares his perspective on tremor treatment research with Dr. Hugo Morales. 2023 Congress virtual access

2023 Congress virtual access

[00:00:00] Dr. Hugo Morales: So welcome to another MDS podcast. Today we're speaking with Dr. Tiago Mestre, who is research and neurologist and movement disorder specialist at the Parkinson's Disease Movement Disorder Center at the University of Ottawa in Ontario, Canada. He's also member of the Evidence-Based Medicine for Tremor.

Thank you for being today with us Tiago. 

View complete transcript

[00:00:31] Dr. Tiago Mestre: Welcome. Thanks for an invitation. 

[00:00:33] Dr. Hugo Morales: So one of the things we know is that tremor is what are the most common phenomenologies of syndromes that we see in the clinic. And I believe that our audience will be interesting to know. What's new or what's coming in the field?

And tell us, tell us about that. 

[00:00:50] Dr. Tiago Mestre: Yes, so definitely tremor is the, is perhaps the one of the most common movement disorders in hypokinesias. When we talk about tremor we [00:01:00] also, I think immediately think about a condition called essential tremor. And of course there are secondary tremors.

There are other conditions that can be assessed with tremor. But really central tremor as taken attention of many of our colleagues. And really it's patients that we see most commonly in our clinic. And so what has happened new? I think perhaps one of, one of the main, I guess, changes that came with the not so recent classification criteria on, on tremors is assuming, providing and assuming that the central tremor is a syndrome. With that, there's the consideration that it's in a way heterogeneous condition, but ultimately I think we need to think as, as a way to, to provide the framework that allow us to understand that heterogeneity and leading to my work in the appraisal of evidence available for interventions for tremor, and specifically for essential tremor allow us to [00:02:00] in a way build better clinical trials and hopefully have more successful therapies available in our practice.

[00:02:06] Dr. Hugo Morales: And is there any new research or in coming clinical trials results that.

Like clinicians should be aware of or wait for the results that may have impact in the way we treat patients with tremor? 

[00:02:19] Dr. Tiago Mestre: That's a very good question. I perhaps would start by laying the land that, you know, essential tremor. Really the interventions we have available in clinical practice have not really changed dramatically.

So we continue to prescribe propanolol, Primidone, topiramate in terms of pharmacological interventions has been perhaps the more robust intervention as demonstrated by evidence-based medicine. Perhaps the most recent I guess addition to it, that's really the surgical therapy.

So MRI guided focused ultrasound has really come up as an evidence support intervention although for more refractory cases of, of patients with essential tremor, [00:03:00] interestingly, in this Congress, there's a number of abstracts trying to look not only a long-term outcome of patients submitted to MRI guided focused alt ultrasound at the VIM of the thalamus but also aspects of the location of the lesioning involvement, for example, of, of the PSA area. So there's a lot of investigation in that specific area of MRI guided focus ultrasound. If we talk about pharmacological therapies I, I'll perhaps highlight that the, in terms of drug classes that have been explored, perhaps the T type calcium channel blockers are the ones that have been more explored?

The results we have so far are a little bit mixed. So there's just one, one single trial where the results are, it's difficult to take a, a conclusive interpretation, just a single trial of phase two trials, but definitely there's other trials ongoing. And you can see some of them in the abstract format in this [00:04:00] Congress.

[00:04:00] Dr. Hugo Morales: Okay. And then do we have any sort of studies on long-term prognosis or how this tremor syndrome behave over time? So, or is anything in the field that's been built up to biological host? Do you understand better about the tremor syndromes including the essential tremor? 

[00:04:17] Dr. Tiago Mestre: That's perhaps one aspect in research that needs to be done. And, and in a way one can think it's due to the frequency of, and the prevalency of, of essential tremor that could be done. But actually I think we're missing that in, the field. 

[00:04:32] Dr. Hugo Morales: And then do you have a message to, our audience and clinicians about how we should classify tremors syndromes?

Do you recommend using the axis one and two or are we still mainly based off the clinical impression that tremor, basal postures tremor at rest, intention, hyperkinetic have we moved really from that aspect. 

[00:04:58] Dr. Tiago Mestre: I think the [00:05:00] efforts of the classification system are to be valued.

Whenever I go back to the that manuscript and that proposal, I find it's a good way to teach about tremor actually for, for residents, fellows. 'cause really provides a very clear framework, of course, not addressing all the questions that we have about tremor syndromes, but provides really a very structured approach to tremors and I think that's very valuable. The whole community has uptake that classification. I think that's another question. But that often happens in terms of how you translate knowledge to the more global community of physicians and perhaps some work needs to be done on that aspect.

[00:05:38] Dr. Hugo Morales: Thank you very much Dr. Mestre and I will invite our audience to go and look all the paper and research that Dr. Mestre publish. But thank you again for coming to today. 

[00:05:50] Dr. Tiago Mestre: You're welcome. [00:06:00] 

Special thank you to:

Dr. Tiago Mestre
Director of the Department of Experimental Neurodegeneration 
University Medical Center
Goettingen, Germany

Hugo Morales Briceño, MD 

Neurology and Movement Disorders Unit, Westmead Hospital

NSW, Australia

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