Essential tremor
In general, the only sign of essential tremor is postural or kinetic tremor in the frequency of 4 to 12 Hz (usually at the lower end of the range in older patients). When essential tremor is severe, some patients also have rest tremor and mild abnormalities of muscle tone and gait. A family history of essential tremor and temporary benefit after drinking alcohol are common.
Essential tremor can be confused with Parkinson disease or other tremors, and the conditions can overlap. Conditions related to essential tremor (eg task-specific tremors, isolated tremor, orthostatic tremor) are not common, and need expert diagnosis and treatment.
Exclude drug- or toxin-induced tremor or systemic illness (eg hyperthyroidism) before starting treatment for essential tremor.
Mild essential tremor does not need treatment.
Propranolol and primidone suppress essential tremor, but primidone is less well tolerated (especially by elderly patients). It is reasonable to start treatment with propranolol, depending on the patient's age and other medical conditions. Use:
1 propranolol 10 mg orally, twice daily. Increase dose slowly over several weeks up to a maximum of 160 mg daily in 2 or 3 divided doses tremor, essential propranolol
OR
2 primidone 62.5 mg orally, at night. If needed, increase dose slowly over several weeks up to 250 mg at night. tremor, essential primidone
If initial therapy is not effective, refer the patient for expert advice. Occasionally, the patient needs propranolol and primidone combined. Some evidence shows that atenolol and sotalol are also effective. A benzodiazepine, gabapentin or topiramate may also be considered. In severe cases of essential tremor, if drug therapy is not effective, the expert may refer the patient to a specialised movement disorders unit for botulinum toxin injections or deep brain stimulation.