From the Guidelines
Essential tremors are typically treated with beta-blockers, such as propranolol, as the first-line medication, as indicated by the most recent evidence 1. The treatment approach for essential tremors involves a combination of lifestyle modifications, medications, and in some cases, surgical interventions.
- Lifestyle modifications include avoiding tremor triggers like caffeine, stress, and certain medications.
- Medications, particularly beta-blockers like propranolol, have been used for over 40 years to treat essential tremors, with other beta-blockers such as metoprolol also being effective depending on the case 1.
- For patients who do not respond to medications, alternative treatments such as botulinum toxin injections can be considered for specific tremor locations.
- In severe cases that significantly impact quality of life, surgical options like deep brain stimulation (DBS) or focused ultrasound thalamotomy may be explored.
- Physical therapy can also play a role in improving muscle control and coordination, although the provided evidence does not directly support its use for essential tremors, it does discuss strategies for functional movement symptoms that could be beneficial 1.
- It's crucial to note that while essential tremors cannot be cured, these treatments can significantly reduce symptoms and improve daily functioning for most patients.
- The choice of treatment should be individualized, considering the patient's specific needs, medical comorbidities, and the potential impact on their quality of life.
From the Research
Treatment Options for Essential Tremors
The treatment of essential tremors includes medications, surgical options, and other forms of therapy 2. The goal of treatment is to improve tremor in patients who experience functional disability.
- Medications: The currently available medications can improve tremor in approximately 50% of patients 2, 3. First-line pharmacological treatments include symptomatic treatment with propranolol, primidone, and topiramate 4. Other medications that may be helpful include gabapentin, benzodiazepines, and botulinum toxin injections into the muscles for head or voice tremor 2, 5.
- Surgical Options: Surgical options are usually considered if the patient still has disabling tremor after medication trials 2. These options include thalamotomy and deep brain stimulation of the thalamus, which provide adequate tremor control in approximately 90% of patients 2, 5. Deep brain stimulation is the procedure of choice for bilateral procedures to avoid adverse effects seen with bilateral ablative procedures 2.
- Other Forms of Therapy: Mild to moderate tremor severity can sometimes be controlled with occupational treatment, speech therapy, psychotherapy, or adaptation of coping strategy 4.
Considerations for Treatment
Treatment for essential tremor is recommended if the tremor causes functional disability 2. The choice of treatment depends on the severity of the tremor, the presence of other medical conditions, and the patient's preferences 4. Shared decision-making with the patient is necessary to customize the management of essential tremor 4.
Efficacy of Treatment
The efficacy of treatment for essential tremor varies depending on the individual patient and the treatment used 3, 5. While some patients may experience significant improvement with medication or surgery, others may not respond as well 2, 3. However, with the available treatment options, adequate tremor control can be achieved in the majority of patients 2.