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Medical Treatment of Essential Tremors
Several medicines are useful in the amelioration of the tremors, however and with the exception of the mild tremors, they do not result in full suppression of the tremors. Even though these medications have some side effects, the advantages of decreasing the intensity of the tremors, in severe cases, overcomes the disadvantages due to the potential side effects.
Alcohol (ethanol) can decrease the intensity of the tremors. Many individuals recognize that drinking alcohol before meals is very helpful. The main side effect is related to the potential risk for addiction to alcohol, and for that reason this is a technique that few practitioners will endorse. Also, when the effects of the ethanol wear off, the tremors return and may even be more intense.
One of the most effective medications for essential tremors is propranolol (Inderal, Inderal LA), which is also an alcohol but with no addition effect. There are sustained-release preparations that prolong the effects of the medication for several hours. Side effects of propranolol are bronchospasm (this cannot be used in persons with asthma), sleepiness, and impotence, among others. There are other medications in this family such as metoprolol (Lopressor, Toprol XL) and nadolol (Corgard) that might have fewer side effects but are not as effective.
Primidone (Mysoline) a drug first used as an antiepileptic medication, is also useful and is indicated when propranolol is not effective. Other anticonvulsant medications [gabapentin (Neurontin, Gabarone), topiramate (Topamax)] have been tried but they are not considered as first-line treatments.
In extreme cases of essential tremor, botulinum toxin might be indicated. However, this treatment is associated with weakness, and its effect is transitory. This treatment may be considered for the most severe cases when propranolol or primidone have failed to relieve symptoms.
In some individuals, mostly those with mild tremors, the use of a wristband with weights in it might help to decrease the magnitude of the oscillations. These devices can be useful when eating or drinking.
Norberto Alvarez, MD
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