Harvard Women's Health Watch

Experts update guidelines for treating essential tremor

About 10 million people in the United States have essential tremor (ET), a movement disorder that causes uncontrollable shaking of the hands and often the head as well, and sometimes a quavering voice. ET is an action tremor, meaning that the shaking is largely absent when you're at rest but increases when you try to use your hands — for example, to pick up a cup or use a fork. (ET is sometimes mistaken for Parkinson's disease, in which it's the other way around: the tremor is noticeable during rest and stops with activity.)

There's no cure for ET, but clinicians have various ways to control the symptoms, including drugs and surgery. The American Academy of Neurology (AAN) has issued updated treatment guidelines, based on a review of 252 studies published since 2005, when the AAN issued its first evidence-based guidelines for the treatment of ET. Results were published in Neurology (Nov. 8, 2011).

Both the 2005 guidelines and the update recommend the antiseizure drug primidone (Mysoline) and the blood pressure drug propranolol (Inderal) as the most effective medications for hand and arm tremor (see the table).

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