Objective: This scoping review aims to assess the current state of knowledge regarding drug-induced tremors, identify critical knowledge gaps, and controversies, and outline a future roadmap for research in this field.

Background: Drug-induced tremors are a common and debilitating side effect of various medications across different therapeutic areas.

Method: A comprehensive literature search was conducted in PubMed and Web of Science to identify relevant studies on drug-induced tremors. Studies were screened and selected based on predefined criteria.  Data extraction and synthesis were performed using a structured proforma to identify key themes, knowledge gaps, and controversies. Findings were synthesized and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) scoping review guidelines.

Results: Of 516 initially screened,61 studies were included in the final review. Implicated drug classes included, antidepressants, antipsychotics, anticonvulsants, bronchodilators, chemotherapeutic agents, and cardiovascular medications. Proposed mechanisms varied, involving neurotransmitter alterations, cerebellar or basal ganglia disruption, direct neurotoxicity, and inflammatory processes. Significant knowledge gaps were identified. Firstly, the precise pathophysiological mechanisms underlying tremor development remain poorly understood. Secondly, there is a lack of consensus on the genetic and environmental determinants that may predispose individuals to developing drug-induced tremors. Additionally, the review highlighted the need for standardized and validated tools for assessing and quantifying tremor severity, as current studies utilize various assessment methods without consensus on the most appropriate and reliable tools. Furthermore, there were controversies surrounding the treatment, reversibility and long-term outcomes of drug-induced tremors, particularly after medication discontinuation or dose adjustment.

Conclusion: Despite their significant impact on patients’ quality of life, our understanding of the underlying mechanisms, risk factors, and optimal management strategies remains limited.

Future roadmap for research in this area should focus on addressing these gaps through well-designed studies, exploring potential therapeutic interventions, and establishing evidence-based guidelines for the prevention, diagnosis, and management of drug-induced tremors.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drug-induced-tremors-a-scoping-review-to-assess-knowledge-gaps-controversies-and-future-directions/