Essential Tremor

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Treatment

Essential tremor often does not require treatment.

Lifestyle changes, such as reducing stress and avoiding caffeine and alcohol, may improve symptoms. Physical therapy may help reduce essential tremor of the hands, arms, legs, and trunk, and speech therapy may be beneficial for people whose voice is affected.

Severe tremor that affects the patient's ability to perform daily tasks and interferes with their quality of life can be treated with medication or surgery.

Medication
Severe essential tremor can be reduced using medication in most (approx. 50–75%) cases. Beta-blockers, such as propranolol (Inderal®), and antiseizure medications (e.g., primidone [Mysoline®], gabapentin [Neurontin®]) often are prescribed.

Beta-blockers usually are prescribed for younger patients because they may cause memory loss and confusion in older patients. Other side effects of beta-blockers include dizziness, fatigue, shortness of breath, and nausea.

Side effects of antiseizure medications include drowsiness, nausea, difficulty concentrating, and lack of balance and coordination (ataxia).

Other medications used to treat essential tremor include benzodiazepines (e.g., diazepam [Valium®], clonazepam [Klonopin®], alprazolam [Xanax®]) and carbonic anhydrase inhibitors (e.g., methazolamide [Glauctabs®, Neptazane®], acetazolamide [Diamox®]).

Side effects of benzodiazepines include drowsiness, fatigue, ataxia, and blood clots (thrombosis). Carbonic anhydrase inhibitors may cause tingling in the hands and feet, ringing in the ears (tinnitus), fatigue, and malaise.

Botulinum toxin injections (BOTOX® Cosmetic) treat essential tremor by producing local muscle weakness. When used to treat tremor in the hands, it may cause weakness in the fingers.

Surgery
Surgery may be recommended when essential tremor is so severe that it

causes disability. Thalamotomy is destruction of a portion of the area deep within the brain that receives sensory messages (thalamus). This procedure relieves essential tremor on one side of the body in approximately 75% of cases. Surgery on both sides of the thalamus rarely is performed because of the high risk for speech loss.

Deep brain stimulation (DBS) is another surgical option when severe essential tremor does not respond to medication. In this procedure, a hair-thin wire is implanted in the thalamus and connected to a device (called a neurostimulator) that is implanted under the collarbone. The neurostimulator sends electrical impulses along the wire to the thalamus to interrupt signals that cause tremor.

Patients can turn DBS on when needed and turn it off when tremors are infrequent (e.g., during sleep). Studies have shown that DBS reduces essential tremor and improves patients' ability to perform daily activities.

Prognosis

Essential tremor is rarely debilitating. Severe cases can usually be treated with medication.

Prevention

Essential tremor cannot be prevented.

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