What are the methods to reduce essential tremors (ET) or action tremors in the hands?

From the Guidelines

To reduce hand tremors, propranolol is a recommended treatment option, as it has been used to treat essential tremor for more than 40 years, with other beta-blockers like metoprolol also being effective depending on the case 1.

Methods to Reduce Hand Tremors

When considering methods to reduce hand tremors, it's essential to prioritize approaches that have a strong evidence base for improving morbidity, mortality, and quality of life.

• Lifestyle modifications are crucial, including limiting caffeine, alcohol, and stress, as these can exacerbate tremors.
• Medications such as propranolol (20-40mg twice daily) are commonly prescribed for essential tremor, with the choice of medication depending on the individual case and medical comorbidities 1.
• For functional tremors, occupational therapy strategies can be beneficial, including superimposing alternative, voluntary rhythms on top of the existing tremor, using the unaffected limb to dictate a new rhythm, and assisting the person to relax the muscles in the limb to prevent cocontraction 1.
• Assistive devices like weighted gloves or stabilizing spoons can help manage daily activities while dealing with tremors.
• It's also important to note that tremors often worsen with fatigue, so adequate rest is crucial, and employing anxiety management and distraction techniques when undertaking a task can be helpful 1.

Key Considerations

• The use of beta-blockers like propranolol for essential tremor is supported by long-standing clinical practice and guidelines 1.
• Occupational therapy strategies for functional tremors focus on encouraging normal movement patterns and resting postures, and employing anxiety management and distraction techniques 1.
• The choice of treatment should be individualized, taking into account the underlying cause of the tremor, medical comorbidities, and the person's overall health status.
• Regular monitoring and follow-up are essential to adjust the treatment plan as needed and to minimize potential adverse effects.

From the Research

Methods to Reduce Hand Tremors

• There are several methods to reduce hand tremors, including pharmacologic treatments, botulinum toxin injections, and surgical procedures 2, 3, 4, 5, 6.
• Pharmacologic treatments that have been shown to be effective in reducing hand tremors include propranolol, primidone, and topiramate 2, 4, 5, 6.
• Botulinum toxin injections may also be effective in reducing hand tremors, but the efficacy can be variable and may be associated with dose-dependent hand weakness 2, 5.
• Surgical procedures such as deep brain stimulation (DBS) and thalamotomy may be considered for severe hand tremors that do not respond to pharmacologic treatments 2, 5, 6.
• Other treatments such as occupational therapy, speech therapy, and psychotherapy may also be helpful in managing mild to moderate hand tremors 6.

Pharmacologic Treatments

• Propranolol and primidone are considered to be the most effective medications for reducing hand tremors 2, 4, 5.
• Topiramate may also be effective in reducing hand tremors, particularly at doses higher than 200 mg/day 4, 5, 6.
• Alprazolam and botulinum toxin type A may be considered as possibly useful treatments for hand tremors 4, 5.

Surgical Procedures

• Deep brain stimulation (DBS) is considered to be a highly efficacious treatment for reducing hand tremors, particularly for severe cases that do not respond to pharmacologic treatments 2, 5, 6.
• Thalamotomy may also be considered as a treatment option for severe hand tremors, although it carries a small risk of major complications 2, 5.
• Focused ultrasound thalamotomy is a new therapy that is attracting increasing interest and may be considered as a treatment option for severe hand tremors 6.