From the Research
Intention tremors are best managed with a treatment plan that includes medications such as propranolol, primidone, or topiramate, as well as physical and occupational therapy, and lifestyle modifications, as evidenced by the most recent and highest quality study 1.
Causes and Symptoms of Intention Tremors
Intention tremors are rhythmic, oscillating movements that occur during voluntary, purposeful actions and worsen as the limb approaches its target. They are caused by damage to the cerebellum or its connections, which disrupts the brain's ability to coordinate smooth movements. Common causes include multiple sclerosis, stroke, traumatic brain injury, alcohol use disorder, and certain medications. Symptoms typically appear during goal-directed movements like reaching for objects, with the tremor amplitude increasing as the person gets closer to their target.
Treatment Options
Treatment depends on the underlying cause but may include medications such as:
- Propranolol (20-40mg three times daily)
- Primidone (starting at 25mg at bedtime and gradually increasing)
- Topiramate (25-200mg daily), with doses higher than 200 mg/day being more effective 1 Physical therapy focusing on coordination exercises and occupational therapy using weighted utensils or adaptive equipment can help manage symptoms. In severe cases unresponsive to medication, deep brain stimulation surgery targeting the thalamus may be considered.
Lifestyle Modifications
Lifestyle modifications like avoiding caffeine, getting adequate sleep, and managing stress are also important as these factors can exacerbate tremors. Patients should work closely with neurologists to determine the underlying cause and develop an appropriate treatment plan. Additionally, botulinum toxin injections may be effective for select patients with MS-associated upper extremity tremor 2.
Key Considerations
It is essential to categorize the tremor based on its activation condition, topographic distribution, and frequency to guide the diagnosis and treatment plan 3. The most common pathologic tremor is essential tremor, which affects 0.4% to 6% of the population, and propranolol, primidone, and topiramate (>200 mg/day) are the pharmacological interventions with robust evidence supporting their efficacy 1.