From the Guidelines
Familial tremor, also known as essential tremor, is typically treated with propranolol, a beta-blocker, as a first-line option, due to its effectiveness in reducing tremor amplitude, as supported by a study published in 2022 1. The treatment approach for familial tremor involves a combination of medications and lifestyle modifications.
- Medications such as propranolol (20-320 mg daily) are commonly used as first-line treatments, with other beta-blockers like metoprolol also being effective in some cases, as mentioned in a study published in Hypertension in 2022 1.
- Alternative options for patients who do not respond to beta-blockers include topiramate, gabapentin, or benzodiazepines like clonazepam.
- In severe cases where medication is ineffective, surgical options such as deep brain stimulation or focused ultrasound thalamotomy may be considered.
- Lifestyle modifications, including reducing caffeine and alcohol intake, using weighted utensils, and employing relaxation techniques to manage stress, can also help alleviate symptoms.
- Physical or occupational therapy can help patients develop strategies to perform daily activities despite their tremor, improving their overall quality of life. The most recent and highest quality study, published in 2022 1, supports the use of beta-blockers, specifically propranolol, as a first-line treatment for familial tremor, making it the preferred choice for managing this condition.
From the Research
Treatment Options for Essential Tremor
- Pharmacological treatments:
- Surgical interventions:
- Unilateral Ventralis intermedius thalamic DBS, radiofrequency thalamotomy, and MRI-guided focused ultrasound thalamotomy are considered possibly useful for limb tremor 2, 3
- Deep brain stimulation, magnetic resonance-guided focused ultrasound, and thalamotomy are alternative forms of therapy for medication refractory and functionally disabling tremor 4, 5
Treatment for Specific Types of Tremor
- Limb tremor: propranolol, primidone, and topiramate (>200 mg/day) are the pharmacological interventions with robust evidence for efficacy 2
- Head tremor: propranolol may reduce head tremor, but there is limited evidence 3
- Voice tremor: botulinum toxin A may reduce voice tremor, but is associated with side effects such as breathiness, hoarseness, and swallowing difficulties 3, 6
Future Treatment Options
- T calcium channel blockers, modulators of GABAA receptors, GABAB receptors, and glutamatergic neurotransmission, and drugs that decrease the expression of LINGO-1 may be interesting options for the future 6
- Novel oral treatments, chemodenervation, and noninvasive neuromodulation are being explored for the treatment of essential tremor 5