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VPA and Lithium – Both Cause Tremor — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersVPA and Lithium – Both Cause TremorSCE Neurology

A 40-year-old man with epilepsy and bipolar disorder is on valproate and lithium. He develops a coarse tremor. Which of his medications is most likely causing the tremor?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Both can cause tremor — valproate causes a postural/action tremor in ~10% of patients, and lithium commonly causes a fine tremor that can become coarse at higher/toxic levels; serum levels of both should be checked

Both valproate and lithium commonly cause tremor. Valproate causes a dose-dependent postural/action tremor in ~10% of patients. Lithium causes a fine tremor in ~30–50% of patients, which can become coarse at higher levels or toxicity. When both are co-prescribed, the tremor risk is additive. Serum levels of both should be checked to exclude toxicity. If levels are therapeutic, dose reduction of one or both may be needed. Propranolol can be added for symptom relief. A: Both contribute. C: Both contribute. D: Both commonly cause tremor. E: Drug-induced tremor must be excluded first.

Reference: BNF; NICE NG217; NICE CG185 Bipolar Disorder