What is the treatment for tremors?

From the Guidelines

Tremor treatment typically involves pharmacological and non-pharmacological interventions. For essential tremor, propranolol [ 1 ] has been used for over 40 years, with other beta-blockers like metoprolol also being effective in some cases [ 1 ]. Non-pharmacological interventions, such as occupational therapy, can also be beneficial in managing functional tremors [ 1 ]. Some strategies used in occupational therapy include:

• Superimposing alternative, voluntary rhythms on top of the existing tremor to gradually slow movement to a complete rest [ 1 ]
• Using the unaffected limb to dictate a new rhythm and entrain the tremor to stillness [ 1 ]
• Assisting the person to relax the muscles in the limb to prevent cocontraction [ 1 ]
• Discouraging cocontraction or tensing of muscles as a method to suppress a tremor [ 1 ] In addition to these strategies, anxiety management and distraction techniques can be helpful in undertaking tasks and managing symptoms [ 1 ]. It is essential to try strategies that encourage normal movement patterns and resting postures before considering other interventions like splinting [ 1 ].

From the FDA Drug Label

CLINICAL PHARMACOLOGY Mechanism of Action Parkinson’s disease is a progressive, neurodegenerative disorder of the extrapyramidal nervous system affecting the mobility and control of the skeletal muscular system. Its characteristic features include resting tremor, rigidity, and bradykinetic movements. Symptomatic treatments, such as levodopa therapies may permit the patient better mobility This is thought to be the mechanism whereby levodopa relieves, symptoms of Parkinson’s disease

The treatment for tremors associated with Parkinson's disease is levodopa therapy 2.

• Levodopa is thought to relieve symptoms of Parkinson's disease, including tremors, by increasing dopamine levels in the brain.
• Levodopa is a metabolic precursor of dopamine that crosses the blood-brain barrier and is converted to dopamine in the brain.

From the Research

Treatment Options for Tremors

• Medications:
  • First-line medications such as levodopa, dopamine agonists, and anticholinergics are effective in controlling tremor 3
  • Second-line medications like clozapine, amantadine, clonazepam, propranolol, and neurontin can be used for patients unresponsive to first-line drugs 3
  • Propranolol and primidone are considered first-choice drugs for essential tremor, with a mean effect size of approximately 50% tremor reduction 4
• Non-pharmacological interventions:
  • Neuromuscular physiotherapy, strength training, and functional electrical stimulation show promise in managing tremor 5
  • Limb cooling, tremor-suppressing orthoses, weighted splints, and vibration therapies need further evaluation 5
• Surgical interventions:
  • Deep brain stimulation at several neuroanatomical sites (thalamus, globus pallidus, subthalamic nucleus) offers good to excellent tremor control with relatively low risk to the patient 3
  • Thalamic deep brain stimulation has been recommended for patients with severe multiple sclerosis tremor 4
• Electromagnetic radiation therapy:
  • Electrical stimulation, magnetic stimulation, and light stimulation methods have been proposed to suppress tremors in Parkinson's disease patients 6
  • Electrical and magnetic stimulation were found to be more effective for tremor suppression at early stages of Parkinson's disease, while light therapy was more effective during later stages 6

Specific Treatments for Different Types of Tremors

• Essential tremor: propranolol, primidone, and topiramate are effective treatments 4
• Parkinsonian tremor: dopamine-based therapies, deep brain stimulation, and levodopa-carbidopa enteral suspension can help manage tremor 3, 7
• Dystonic limb tremor: anticholinergics may be effective 4
• Head and voice tremor: botulinum toxin can improve symptoms 4
• Orthostatic tremor: gabapentin and clonazepam are often recommended 4
• Functional (psychogenic) tremor: antidepressants and multidisciplinary treatment may be beneficial 4