What are the best treatment options for essential tremor?

Q. I think I have essential tremor — all the symptoms fit. The tremors have dramatically increased over the last several months and now I can't hold my head still. What medication would help with this?

A. Essential tremor is a common condition in which one or more parts of the body shake involuntarily. It usually starts in midlife or later. The most common initial symptom is shaking of the hands, but other areas, including the arms, legs, and head, are frequently involved. A trembling voice may be a symptom of essential tremor.

The shakiness is often called an "intention tremor" because it worsens when a person is trying to do something. At rest or during sleep, the tremor tends to improve or go away altogether.

The name of this condition indicates that the cause is unknown and that it occurs on its own, without another explanation, such as Parkinson's disease (another common cause of tremor). The condition may run in families. In fact, genetic mutations have been linked to benign familial tremor.

For mild symptoms, no treatment is needed. Avoiding caffeine and stress and getting plenty of rest can be helpful. In social situations, slowly consuming one alcoholic beverage can reduce the tremor.

However, for symptoms that impair quality of life, most doctors prescribe either a beta blocker, usually propranolol, or primidone, an antiseizure medicine. If the initial choice doesn't work well enough, you can try the other, and sometimes taking both helps the most. Alternative medications are topiramate and gabapentin; both are antiseizure drugs, more often used for other indications.

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