What is the recommended treatment for essential tremor?

From the Guidelines

The recommended treatment for essential tremor is propranolol, which has been used for over 40 years and may be effective in reducing tremor amplitude. According to a recent study published in 2022 in the journal Hypertension 1, propranolol has been a longstanding treatment option for essential tremor, with other beta-blockers like metoprolol also potentially being effective depending on the individual case.

Key Considerations

• The treatment of essential tremor should prioritize medications that have a proven track record of efficacy, such as propranolol.
• Other beta-blockers, for example, metoprolol, may also be considered as alternative options.
• The choice of medication should be individualized based on the patient's specific needs and medical comorbidities.

Treatment Approach

• Propranolol is a well-established treatment for essential tremor, with a long history of use and a significant body of evidence supporting its efficacy 1.
• The dosage of propranolol may vary depending on the individual patient's response and tolerance, but it is typically started at a low dose and gradually increased as needed.
• Other medications, such as primidone, topiramate, gabapentin, or benzodiazepines, may be considered for patients who do not respond adequately to propranolol or have contraindications to its use.

From the Research

Treatment Options for Essential Tremor

The recommended treatment for essential tremor includes medications, surgical options, and other forms of therapy. The treatment is recommended if the tremor causes functional disability [ 2 ].

• Medications:
  • Primidone and propranolol are considered first-line medications for the treatment of essential tremor [ 2, 3 ].
  • Topiramate, atenolol, and alprazolam are also considered effective [ 4, 5 ].
  • Botulinum toxin A may reduce limb tremor, but may cause dose-dependent weakness [ 4, 5 ].
• Surgical Options:
  • Deep brain stimulation (DBS) of the thalamus is used as an alternative to pharmacological therapy in patients who fail to adequately respond to medical therapy [ 2, 4 ].
  • Thalamotomy and MRI-guided focused ultrasound thalamotomy are also considered possibly useful [ 5 ].
• Other Forms of Therapy:
  • Botulinum toxin injections into the muscles may provide relief from tremor, especially for head or voice tremor [ 2 ].

Initiating Treatment

Treatment for essential tremor should be initiated with either primidone or propranolol [ 2 ]. If either primidone or propranolol do not provide adequate control of the tremor, then the medications can be used in combination [ 2 ].

Efficacy of Treatment

The currently available medications can improve tremor in approximately 50% of the patients [ 2 ]. Surgical options, such as thalamotomy and deep brain stimulation of the thalamus, provide adequate tremor control in approximately 90% of the patients [ 2 ].