How is Essential Tremor treated

How is Essential Tremor treated? 

Propranolol remains the most effective medication for Essential Tremor, although other beta-blockers also have an antitremor activity.

Daily doses of up to 360 mg may be necessary to control tremor.

Primidone, an anticonvulsant medication, also has been shown to be highly effective for the treatment of Essential Tremor in both open and controlled studies. It should be started at low doses (25 mg at bedtime) to avoid the occasional acute idiosyncratic toxic reaction characterized by severe nausea, vomiting, sedation, confusion, and ataxia. 

Less effective but occasionally useful medications are lorazepam, clonazepam, diazepam, alprazolam, gabapentin, and topiramate.

A double-blind, placebo-controlled trial revealed mild to moderate benefit of botulinum toxin injections in the treatment of severe hand tremor.

Alcohol, although effective in approximately two-thirds of patients with Essential Tremor, is not recommended because of the possibility of addiction, although Essential Tremor does not appear to increase the risk of alcoholism.

For intractable Essential Tremor, contralateral thalamotomy is effective and well tolerated.

The current main surgical treatment for Essential Tremor is high-frequency thalamic stimulation (deep brain stimulation [DBS]).

Gamma knife thalamotomy has also been shown to suppress completely disabling Essential Tremor. 

Sources

• Shill HA, Adler CH, Sabbagh MN, Connor DJ Cabiness JN, Hentz JG, et al.: Pathological findings in prospectively ascertained essential tremor subjects. Neurology 70(16 Pt 2):1452-1455, 2008. 
• Shahed J, Jankovic J: Exploring the relationship between essential tremor and Parkinson’s disease. Parkinsonism Relat Disord 13(2):67-76, 2007. 
• Fekete R, Jankovic J: Revisiting the relationship between essential tremor and Parkinson’s disease. Mov Disord 26:391-398, 2011. 
• Thenganatt MA, Jankovic J: Parkinson disease subtypes. JAMA Neurol 71(4):499-504, 2014. 
• Shaikh AG, Jinnah HA, Tripp RM, Optican LM, Ramat S, Lenz FA, et al.: Irregularity distinguishes limb tremor in cervical dystonia from essential tremor. J Neurol Neurosurg Psychiatry 79(2):187-189, 2008. 
• Elble RJ. Defining dystonic tremor. Curr Neuropharmacol 11(1):48-52, 2013. 
• FitzGerald PM, Jankovic J: Orthostatic tremor: an association with essential tremor. Mov Disord 6(1):60-64, 1991. 
• Gerschlager W, Munchau A, Katzenschlager R, Brown P, Rothwell JC, Quinn N, et al: Natural history and syndromic associations of orthostatic tremor: a review of 41 patients. Mov Disord 19(7):788-795, 2004. 
• Spiegel J, Fuss G, Krick C, Dillmann U: Impact of different stimulation types on orthostatic tremor. Clin Neurophysiol 115(3):569-575, 2004. 
• Yaltho TC, Ondo WG: Orthostatic tremor: a review of 45 cases. Parkinsonism Relat Disord 20(7):723-725, 2014. 
• Louis ED, Ford B, Barnes LF: Subtypes of essential tremor. Arch Neurol 57:1194-1198, 2000. 
• Jankovic J, Schwartz K, Clemence W, Aswad A, Mordaunt J: A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor. Mov Disord 11(3):250, 1996. 
• Ondo WG, Jankovic J, Connor GS Pahwa R, Elble R, Stacy MA, et al.: Topiramate in essential tremor: a double blind, placebo controlled trial. Neurology 66(5):672-677, 2006. 
• Kondziolka D, Onq JG, Lee JY, Moore RY, Flickinger JC, Lunsford LD: Gamma knife thalomotomy for essential tremor. J Neurosurg 108(1):111-117, 2008. 
• Schneider SA, Deuschl G: The treatment of tremor. Neurotherapeutics 11(1):128-138, 2014. 
• Rajput AH, Rajput A: Medical treatment of essential tremor. J Cent Nerv Syst Dis 6:29-39, 2014. 
• Baizabal-Carvallo JF, Kagnoff MN, Jimenez-Shahed J, Fekete R, Jankovic J: The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond. J Neurol Neurosurg Psychiatry 85(5):567-572, 2014.