Management of
primary orthostatic tremor (POT) remains challenging, and medication is often ineffective. We report the case of a 53-year-old female with orthostatic
tremor for 6 years who was refractory to
gabapentin,
clonazepam,
primidone and
propranolol.
After treatment with 4 mg/day
perampanel, she reported almost complete resolution of
tremor. The diagnosis of POT was confirmed by
tremor analysis using surface electromyography. Our report shows the potential use of the novel
AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist
perampanel for the treatment of POT. To date, only two similar patients, one refractory to treatment and the other previously treated with
clonazepam only, have been reported. We would like to note that our patient was refractory to all previous
therapy and responded to a low dose of
perampanel without side effects. The striking clinical improvement suggests a putative role of
glutamate in the pathophysiology of orthostatic
tremor.