Essential tremor

Alternative Names

Treatment

Treatment may not be necessary unless the tremors interfere with the ability to perform daily activities or if they are considered embarrassing to the patient.

Medications help relieve symptoms in most patients. Two medications are considered the first line of therapy: propranolol and primidone. Propranolol blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline. Primidone is an anti-seizure medication, which also control the function of some neurotransmitters. The drugs can have significant side effects.

Side effects of propranolol include:

• Fatigue
• Shortness of breath (people with asthma should not use this drug)
• Slowing of the heart rhythm
• Nose stuffiness

Side effects of primidone include:

• Drowsiness
• Difficulty concentrating
• Nausea
• Poor gait (walking style), balance, and coordination

Other medications that may reduce tremors include anti-seizure drugs such as gabapentin, topiramate, mild tranquilizers such as alprazolam or clonazepam, and calcium-channel blockers (flunarizine and nimodipine).

Botox injections, given in the hand, have been used to reduce tremors by weakening local muscles.

In severe cases, surgery may be an option. Such surgery usually involves implanting a device called deep brain stimulator in a specific area of the brain called the basal ganglia.

Caffeine, found in substances such as coffee and soda, and other stimulants should be avoided.

Alcoholic beverages in small quantities may decrease tremors but can lead to alcohol dependence if used in excess. How alcohol decreases an essential tremor is unknown.

Outlook (Prognosis)

An essential tremor is not a dangerous condition, but it may be annoying and embarrassing.

Possible Complications

If it is severe, essential tremor can mildly interfere with activities, especially fine motor skills such as writing. Speech is occasionally involved. Medications can cause side effects.

When to Contact a Medical Professional

Call for an appointment with your health care provider if essential tremor is interfering with ability to perform daily activities.

Call your health care provider if side effects of medications occur, including fainting, very slow heart rate, confusion or changes in alertness, lack of coordination, problems walking, and prolonged nausea/vomiting.