Essential tremor is a common neurologic problem. It should be differentiated from secondary causes of tremor and Parkinson disease.
Impact of essential tremor
Essential tremor causes motor dysfunction (e.g. a dentist may have to quit his/her job). However, more importantly, the tremor can have a psychological impact on the patient, especially since it usually gets worse in social situations.
Essential tremor is a clinical diagnosis. A thorough review of the medical history and medication exposures is a good start. Laboratory and imaging tests may be ordered to rule out a secondary cause.
The two first-line agents in drug therapy for essential tremor are:
- nonselective beta-blocker propranolol (Inderal)
- antiepileptic primidone (Mysoline)
They can be used alone or in combination.
Severe, resistant, or atypical cases should be referred to a specialist. Botulinum toxin injection and deep brain stimulation are reserved for resistant tremor or for patients who do not tolerate drug therapy.
Dr. Young from Swedish Medical Center discusses some of the new treatments for essential tremor in this video:
Essential tremor: Choosing the right management plan for your patient. CCJM, 2011.