There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Treatment Options for Parkinson's Disease Tremor
The following are treatment options for Parkinson's disease (PD) tremor:
- Medications:
- Levodopa: first-line therapeutic option for all motor symptoms, including tremor 1, 2, 3, 4
- Dopamine agonists: can lead to further tremor reduction when added to levodopa 1, 2, 4
- Anticholinergics: can lead to further tremor reduction, but have a limited role due to adverse effects 1, 2, 3, 4
- Propranolol: may improve resting and action tremor, and can be considered as an adjunct to levodopa 2
- Clozapine: may be considered as an adjunct to levodopa, despite its unfavorable adverse effect profile 2
- Alternative Therapies:
- Botulinum toxin injection: effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies 1
- Deep brain stimulation: most well-established advanced therapy, with long-term efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations 1, 2, 4, 5
- Magnetic resonance-guided focused ultrasound: promising modality, with the advantage of being incisionless 1, 2
- Cortical and peripheral electrical stimulation: non-invasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor 1
- Surgical Interventions:
- Thermocoagulation: offers good to excellent tremor control with relatively low risk to the patient 4
- Deep brain stimulation at several different neuroanatomical sites (thalamus, globus pallidus, subthalamic nucleus): offers good to excellent tremor control with relatively low risk to the patient 4, 5