What is the treatment for essential tremor (ET)?

From the Guidelines

The primary treatment for essential tremor is propranolol, a beta-blocker, which has been used for over 40 years and is considered a first-line option. According to a recent study published in 2022 in the journal Hypertension 1, propranolol has been effective in treating essential tremor, and other beta-blockers like metoprolol may also be effective depending on the case.

Key Points to Consider

• The dosage of propranolol can vary, but it is typically prescribed in a range of 20-320 mg daily.
• Other medication options, such as primidone, topiramate, gabapentin, or benzodiazepines like clonazepam, may be considered if propranolol is not effective or tolerated.
• Lifestyle modifications, including reducing caffeine and alcohol intake, using weighted utensils, and practicing stress management techniques, can help alleviate symptoms.
• Physical or occupational therapy can help develop strategies to minimize the impact of tremor on daily activities.
• In severe cases, surgical interventions like deep brain stimulation or focused ultrasound may be considered.

Treatment Approach

The treatment approach for essential tremor should be individualized, taking into account the severity of the tremor, its impact on quality of life, and potential medication side effects, as indicated by the study 1. By prioritizing propranolol as the primary treatment option and considering other medications and lifestyle modifications as needed, patients with essential tremor can experience improved symptom management and quality of life.

From the Research

Treatment Options for Essential Tremor

The treatment of essential tremor can be divided into several approaches, including:

• Pharmacological treatments:
  • First-line treatments include propranolol, primidone, and topiramate 2, 3, 4, 5, 6
  • Other medications such as alprazolam and botulinum toxin type A may be considered as possibly useful 3, 4
• Non-pharmacological treatments:
  • Occupational therapy, speech therapy, and psychotherapy may be beneficial for mild to moderate tremor severity 2
  • Adaptation of coping strategies may also be helpful 2
• Surgical interventions:
  • Deep brain stimulation (DBS) of the thalamic and subthalamic region is a current standard for severe tremors 2, 3, 5, 6
  • Focused ultrasound thalamotomy is a newer therapy that may be considered for patients with substantial medical comorbidities 3, 6
  • Radiofrequency lesioning and radiosurgery are other options, although they are less commonly used 2, 3

Considerations for Treatment

When considering treatment options for essential tremor, it is essential to:

• Exclude treatable etiologies, as some cases of essential tremor may be caused by underlying conditions that can be treated 2
• Consider the severity and location of the tremor, as well as the presence of any additional neurological symptoms 5, 6
• Involve the patient in shared decision-making to customize the management approach 2
• Monitor the patient's response to treatment and adjust the approach as needed 2, 3, 4, 5, 6