From the Guidelines
Treatment of essential tremor should prioritize propranolol as the first-line medication, given its 40-year history of effective use, as noted in a 2022 study published in Hypertension 1. When considering treatment options for essential tremor, it's crucial to weigh the benefits and potential side effects of each approach.
- Medication options include:
- Propranolol, a beta-blocker that has been used for over 40 years to treat essential tremor, with other beta-blockers like metoprolol potentially being effective as well, as indicated in the 2022 study 1.
- Other medications such as primidone, topiramate, gabapentin, or benzodiazepines like clonazepam may be considered for patients who do not respond to propranolol.
- Non-medication approaches are also vital and include:
- Avoiding tremor triggers such as caffeine, stress, and lack of sleep.
- Physical and occupational therapy to develop strategies for managing daily activities.
- Lifestyle modifications, including the use of weighted utensils, voice recognition software, and wrist weights, can help manage symptoms. For severe cases that are refractory to medication, surgical options like deep brain stimulation (DBS) of the thalamus or focused ultrasound thalamotomy may be considered, as they can disrupt the abnormal brain circuits causing the tremor. Given the potential side effects and the invasive nature of surgical options, they should be reserved for cases where other treatments have failed, emphasizing the importance of a stepped care approach, starting with the least invasive and most established treatments like propranolol, as supported by the most recent evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Essential Tremor
The treatment of essential tremor depends on the severity of the tremor, its location, and the risk-benefit ratios of the treatment options 2.
- Medications: The first-line treatment for essential tremor is pharmacotherapy with propranolol, primidone, and gabapentin 3. Other medications that may be helpful include benzodiazepines, topiramate, and botulinum toxin injections for head and voice tremor 4, 2.
- Surgical Options: For patients with severe, debilitating tremor that is resistant to medication, surgical options such as thalamotomy and deep brain stimulation of the thalamus are available 4, 3. Deep brain stimulation has been shown to be a very efficacious and safe procedure in the treatment of essential tremor 3.
- Alternative Therapies: Other agents that may be effective in reducing tremor include ethanol, levetiracetam, and zonisamide 2. Botulinum toxin injections can be effective in some tremor patterns, especially wrist flexion/extension and head tremor 2.
Medication Management
The currently available medications can improve tremor in approximately 50% of patients 4. If the tremor is disabling, treatment should be initiated with either primidone or propranolol 4. If either primidone or propranolol do not provide adequate control of the tremor, then the medications can be used in combination 4.
- Propranolol: Propranolol has been shown to be effective in reducing tremor in patients with essential tremor 5. It is often used as a first-line treatment for essential tremor 4, 3.
- Primidone: Primidone is another medication that is commonly used to treat essential tremor 4, 3. It can be used alone or in combination with propranolol to control tremor.