From the Guidelines
Essential tremor is a clinical condition characterized by a bilateral, largely symmetric postural or kinetic tremor, primarily affecting the hands and forearms, with a frequency of 4-12 Hz, and is often treated with beta-blockers such as propranolol or metoprolol, as indicated by recent studies 1. The clinical features of essential tremor include:
- A tremor that worsens with emotional stress
- Improvement with alcohol consumption in about 50-70% of patients
- A positive family history in 50-70% of cases
- A gradual onset, slow progression over years, and greater prominence on the dominant side
- Absence of rest tremor, cogwheel rigidity, or bradykinesia, distinguishing it from Parkinsonian tremor
- Worsening of tremor when performing precision tasks like writing, eating, or drinking Key characteristics of essential tremor, as supported by recent research 1, include its responsiveness to beta-blocker treatment, such as propranolol, which has been used for over 40 years, and other beta-blockers like metoprolol, which may also be effective depending on the case. The diagnosis of essential tremor is primarily clinical, based on the characteristic tremor pattern and the absence of other neurological signs, and it can significantly impact quality of life, especially as it progresses, leading to functional disability and social isolation in severe cases.
From the Research
Clinical Features of Essential Tremors
- Essential tremor (ET) is characterized by kinetic and postural tremor, and is one of the most common tremor disorders in adults 2
- The condition can affect the upper limbs, head, and voice, with tremor present in bilateral upper extremities for at least three years 3
- Additional clinical features associated with ET include cognitive impairment, psychiatric disorders, and hearing loss, with some patients categorized as "essential tremor plus" if they have additional neurologic symptoms 3
Treatment Options
- First-line treatments for ET include propranolol and primidone, which can reduce limb tremor severity by half 4
- Other pharmacological interventions that may be effective include topiramate, alprazolam, and botulinum toxin type A, although their efficacy and safety profiles vary 2, 5, 6
- Surgical interventions such as deep brain stimulation, magnetic resonance-guided focused ultrasound, and thalamotomy may be considered for patients with medication-refractory and functionally disabling tremor 5, 4, 3
Tremor Locations and Treatment
- Limb tremor can be treated with propranolol, primidone, and other pharmacological interventions, as well as surgical options like deep brain stimulation and thalamotomy 2, 5, 4
- Head tremor and voice tremor may be treated with botulinum toxin injections, although evidence for these locations is limited 2, 6, 4
- Treatment approaches may vary depending on the location and severity of the tremor, as well as the presence of additional neurologic symptoms 4, 3