The impact of pregabalin and gabapentin on essential tremor: a systematic review and meta-analysis

Essential tremor (ET) is a common neurological disorder characterized by involuntary rhythmic oscillations. Emerging evidence suggests that gabapentinoids, including gabapentin and pregabalin, may be effective in managing ET. This study aimed to assess the efficacy of gabapentinoids in treating ET by analyzing data from randomized controlled trials (RCTs).

A systematic search was conducted across various databases to identify relevant RCTs utilizing gabapentin or pregabalin. Tremor severity was evaluated using the total tremor score (TTS) and accelerometry.

In a between-group meta-analysis of seven RCTs (N = 235), gabapentinoids did not significantly outperform placebo in reducing TTS or its subscales. Accelerometry data suggested a non-significant trend favoring gabapentinoids.However, within-group analyses demonstrated a significant reduction in TTS from baseline with gabapentinoids overall (P = 0.016), an effect driven by gabapentin (P = 0.021) but not pregabalin. No significant within-group improvements were observed for TTS subscales or accelerometry measures post-treatment.

This meta-analysis found no significant advantage of gabapentinoids over placebo in ET. However, within-group analyses demonstrated that gabapentin-but not pregabalin-significantly reduced tremor severity from baseline, suggesting a potential therapeutic signal that warrants further investigation. Larger, standardized trials are needed to identify which patient subgroups, if any, may benefit from gabapentin therapy.