How is an essential tremor (ET) treated?

Dr. Jeanne Morrison, PhD
Family Practitioner

There is no cure for most tremors. The appropriate treatment depends on the accurate diagnosis of the cause.

Some tremors respond to treatment of the underlying condition. For example, in some cases of psychogenic tremor, treating the patient's underlying psychological problem may cause the tremor to disappear.

Symptomatic drug therapy is available for several forms of tremor. Drug treatment for parkinsonian tremor involves levodopa and/or dopamine-like drugs, such as bromocriptine mesylate  and ropinirole. Other drugs used to lessen parkinsonian tremor include amantadine hydrochloride and anticholinergic drugs.

Essential tremor may be treated with propranolol or other beta blockers (such as nadolol) and primidone, an anticonvulsant drug.

Cerebellar tremor typically does not respond to medical treatment. Patients with rubral tremor may receive some relief using levodopa or anticholinergic drugs.

Dystonic tremor may respond to clonazepam, anticholinergic drugs, and intramuscular injections of botulinum toxin. Botulinum toxin is also prescribed to treat voice and head tremors and several movement disorders.

Clonazepam and primidone may be prescribed for primary orthostatic tremor.

Physical therapy may help to reduce tremor and improve coordination and muscle control for some patients. A physical therapist will evaluate the patient for tremor positioning, muscle control, muscle strength, and functional skills. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.

Surgical intervention, such as thalamotomy and deep brain stimulation, may ease certain tremors. These surgeries are usually performed only when the tremor is severe and does not respond to drugs.

Deep brain stimulation (DBS) uses implantable electrodes to send high-frequency electrical signals to the thalamus.

The most common side effects of tremor surgery include dysarthria (problems with motor control of speech), temporary or permanent cognitive impairment (including visual and learning difficulties), and problems with balance.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

The first step in treating essential tremor is avoiding caffeine and stressful situations. After that, medications, such as beta blockers or anti-seizure medicines, can sometimes help. Up to three in 10 people with essential tremor do not get better with medication. Surgery is an option for them.

Medical treatment depends on the underlying cause of tremor, and in most cases there is no cure. Treatment may include:

  • Beta blockers, primidone and other drugs for essential tremor.
  • Levodopa or dopamine-like drugs for Parkinsonian tremor.
  • Intramuscular injections of botulinum toxin for dystonic tremor.

Doctors may also recommend eliminating substances that can trigger tremors including caffeine and other stimulants from the diet. Patients with tremor often benefit from physical therapy, which can help improve coordination.

If tremor is severe and does not respond to medical treatment, doctors may consider surgical intervention. Deep brain stimulation (DBS) has become an important tool in the treatment of tremor. In DBS neurosurgeons implant a device that acts like a pacemaker for the brain. The device reduces or eliminates the activity of the areas overly active in tremor, thereby minimizing symptoms. DBS also enables many patients to reduce their dependence on medications.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.