From the Guidelines
Pediatric tremors should be evaluated and managed based on their underlying cause, with a focus on treating any associated conditions and avoiding triggers that may exacerbate the tremor. When considering the management of pediatric tremors, it is essential to first identify and treat any underlying cause, as seen in children with Williams syndrome, who may exhibit signs of cerebellar dysfunction, such as ataxia and tremor, which may increase with age 1. For children with physiologic tremor, reassurance and avoiding triggers like caffeine may be sufficient. However, for more severe cases or those associated with specific conditions, targeted treatments are necessary. In the case of Williams syndrome, symptoms of headache, dizziness, and dysphagia should prompt the clinician to consider a pediatric neurology referral for evaluation for Chiari malformation 1. Some key points to consider in the management of pediatric tremors include:
- Identifying and treating any underlying cause
- Avoiding triggers that may exacerbate the tremor
- Considering targeted treatments for specific conditions, such as Williams syndrome or Wilson's disease
- Regular follow-up to monitor treatment efficacy and adjust management as needed
- Referral to a pediatric neurologist for evaluation and management of complex cases, such as those with suspected Chiari malformation 1. It is also important to note that while some studies may discuss the use of epinephrine in children, such as in the management of anaphylaxis, this is not directly relevant to the management of pediatric tremors 1. Therefore, the focus should remain on evaluating and managing the underlying cause of the tremor, rather than considering unrelated treatments.
From the Research
Definition and Classification of Pediatric Tremors
- Tremor is a common movement disorder in pediatric neurology practice, which can be primary or secondary to underlying neurologic or systemic diseases 2.
- Proper classification of tremor is essential for specific diagnosis and prompt adequate management.
Treatment Options for Pediatric Tremors
- The treatment of essential tremor depends on the tremor severity, location, and risk-benefit ratios, with mild to moderate tremor usually responding to oral agents such as noncardiac selective beta-blockers or primidone 3.
- Other agents, including ethanol, topiramate, benzodiazepines, gabapentin, levetiracetam, and zonisamide, may be effective in treating essential tremor 3, 4.
- Botulinum toxin injections are effective in some tremor patterns, especially wrist flexion/extension and head tremor 3, 4, 5.
- Surgical interventions, such as deep brain stimulation, magnetic resonance-guided focused ultrasound, and thalamotomy, may be considered for severe tremor 3, 5, 6.
Pharmacological Treatment of Essential Tremor
- Propranolol and primidone are the most commonly used pharmacological treatments for essential tremor, with topiramate being an alternative option 4, 6.
- The use of drugs other than propranolol and primidone has not shown a greater degree of efficacy, although certain evidence-based guidelines suggest that topiramate and phenobarbital could be alternative drugs 4.
- New therapeutic options, such as T calcium channel blockers, modulators of GABAA receptors, GABAB receptors, and glutamatergic neurotransmission, and drugs that decrease the expression of LINGO-1, are being explored 4.