Treatment of Essential Tremor

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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You may worry it’s a tremor from Parkinsons, but often it’s not. Essential tremor (ET) is the most common tremor disorder in adults and often affects patients’ ability to write and eat. The head and voice are commonly affected, and many of you remember Katherine Hepburn’s essential tremor as the classic example. Once your doctor has told you that your tremor is ET and not something else, you will wonder what your options for treatment are. Here you go:

•  Propranolol (Inderal) is the medication used most frequently and successfully to treat ET. Propranolol is known as a beta-blocker and is the only medication approved by the FDA to treat ET. Your dose will be gradually increased to achieve optimal response, with a close eye on blood pressure while you are taking it. Propranolol is most effective for upper limb tremor and less effective for head and voice tremors.

•  Primidone (Mysoline) is also commonly used for ET and may be added to propranolol as dual therapy. Primidone is related to phenobarbital and is most effective for hand tremor. It reduces tremor amplitude by 60-70%.

•  Unfortunately, 30% to 50% of patients will not respond to either primidone or propranolol, and that’s where it gets tricky because though other options have been studied, they don’t work all that well.

•  Though olanzapine (Zyprexa) has been studied, it does not appear to be any better than propranolol for tremor.

•  What doesn’t work? Keppra (levetiracetam), a seizure medication, was tested for essential tremor and doesn’t work. Sibelium (flunarizine) should also not be considered for treatment of ET. Though not completely ruled out yet, we don’t have any evidence that Lyrica or Zonegran help for ET either.

Dr O.

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