New Guidelines for Treating Essential Tremor

Oct. 19, 2011 -- New treatment recommendations for a movement disorder called essential tremor were introduced this week by the American Neurological Association. The latest advice describes the most effective drugs and surgeries to help ease the trembling hands, head, or voice seen in this condition.

A panel of nine experts reviewed more than 250 recent studies in revising the treatment guidelines. They were published online in the journal Neurology and were last updated in 2005.

Essential tremor (ET) is the most common type of tremor and affects about 10 million Americans. A person with this disorder has periods of uncontrollable shaking. This shakiness might be seen in the hands, or as a nodding head or a quivering voice. 

Essential tremor occurs when muscles are used, such as when holding a glass in your hand. The tremors seen in Parkinson's disease occur when muscles relax, such as when holding your hands in your lap or resting your arms at your sides.

Mild cases of ET might not need any treatment, although people might feel embarrassed about seeming shaky.

Drug Recommendations

When trembling interferes with a person's life, doctors are most likely to prescribe the drugs propranolol (Inderal, InnoPran), a beta-blocker medication used sometimes to treat high blood pressure, or primidone (Mysoline), which is sometimes used to control seizures.

Although the scientific evidence suggests these two drugs are the most effective treatments for tremor, 30% to 50% of patients might not improve or can't tolerate either one of them. So "these first-line medications for ET clearly fail to meet the needs of many patients," write the guideline authors.

If these treatments don't reduce the tremors, the guidelines suggest some other helpful alternatives. These include: two seizure drugs, gabapentin (Fanatrex, Gabarone, Horizant, Neurontin) or topiramate (Topamax, Topiragen); two other high blood pressure medications, atenolol (Senormin,Tenormin) or sotalol (Betapace, Sorine); or the anxiety drug alprazolam (Niravam, Xanax).

"More and better research is needed since not all people with essential tremor benefit from these drugs," says guidelines researcher Theresa A. Zesiewicz, MD, in a news release. Zesiewicz is a neurologist at the University of South Florida Health in Tampa.

When people are not benefiting from medication, the guidelines call for doctors to consider surgical therapy as an option. Deep brain stimulation of the part of brain called the thalamus can be performed for severe tremors. The procedure involves implanting an electrical device in the brain.

A second surgical procedure, called unilateral thalamotomy, can also be performed on the thalamus area of the brain. This procedure has been shown to reduce tremors.