Clinical guidelines: Neurology experts rank treatments for essential tremor

Clinical guidelines

Neurology experts rank treatments for essential tremor

Chances are you know someone who has essential tremor, or maybe you have it yourself. About 10 million women and men in the United States have the condition, which causes the hands and head to shake and the voice to quaver. The actress Katherine Hepburn, whose delivery was unmistakably affected by the disorder, gave essential tremor its best-known public face.

Although there is no cure, clinicians have long had a variety of options, including drugs and surgery, for treating the symptoms. But these approaches haven't all been compared head to head, and studies evaluating them haven't always agreed, so many clinicians and patients have been left uncertain about the best treatment plan. In an effort to clear up the confusion, an American Academy of Neurology (AAN) panel reviewed more than 200 studies of medical and surgical treatments for essential tremor and formulated practice guidelines, which are published in the June 28, 2005, issue of Neurology.

The guidelines rank various therapies based on the quality of the scientific evidence available for them. For example, the two medications that received the strongest recommendation — propranolol and primidone — were judged "effective" in reducing tremors (by as much as 50%) in two or more randomized controlled clinical trials, which are considered the gold standard for medical research. Propranolol (Inderal) and its long-acting version (Inderal LA) are beta blockers, also used to treat high blood pressure and performance anxiety. Primidone (Mysoline) is an antiseizure medication. Several other drugs (including antihypertensive and antiseizure medications as well as certain anti-anxiety drugs) help control tremors, although the evidence for their effectiveness isn't as strong. These medications are deemed "probably" or "possibly" effective.

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