Effects of topiramate in patients with cerebellar tremor

Purpose: To evaluate the safety and potential beneficial effect of topiramate (TPM) as monotherapy or adjunctive therapy to carbamazepine (CBZ) in patients with cerebellar tremor. Methods: Nine patients with cerebellar tremor participated a 4-week, open-label, prospective-controlled trial. TPM was given as monotherapy ( n=7 cases), or in combination with CBZ ( n=2 cases), at dosages ranging from 25 mg twice daily to 100 mg twice daily. The severity of tremor was assessed clinically on a 0–4 scale, by tremograms, by the Patients Global Impressions Scale, and by a “free writing” task at baseline and after 4 weeks. Results: TPM was discontinued in four patients due to adverse effects (sedation=2; cognitive impairment=2; increased aggressiveness=2; asthenia=1). During TPM, all patients improved. The mean tremor amplitude, compared with the baseline period, was reduced from 20% to 75%. After TPM, mean clinical scores of postural tremor and kinetic tremor decreased from 2.1±0.8 to 0.9±0.9 and from 2.1±1 to 1.4±1 ( P