Medicines for essential tremor | Is essential tremor curable?

Medicines for essential tremor

When treating essential tremor, the first step is to consider the severity of the symptoms and the impact on daily life. Some patients have only a slight tremor under tension. If there is no or only a moderate impairment, often no therapy is necessary.

Otherwise, treatment with medication can be tried. For this purpose, patients under 60 years of age primarily use beta-blockers, especially propranolol has proven to be effective. Other so-called non heart specific (cardioselective) beta blockers can also be used.

The task of the neurologist is to adjust the dose in such a way that the best possible effect is achieved with as few side effects as possible. In the case of therapy failure or patients over 60 years of age, the antiepileptic Primidon is primarily used. 01Patients over 60 years of age are more likely to use Primidon as their first-choice drug, while beta-blockers are usually second choice here.

Primidone is originally used to treat epilepsy, but is also used in essential tremor. Primidone can also be used in patients under 60 years of age if beta-blockers such as propranolol do not show sufficient effect. If both drugs do not show sufficient effect, they can also be combined.

Benzodiazepines are very strong sedatives and sleeping pills which are subject to the narcotics law in Germany. Their use should be carefully considered, as they can have dangerous side effects and are very addictive. Therefore, they should only be used when really necessary and then only for a short time. Benzodiazepines are not effective in essential tremor and should not be used in this case according to the guidelines of the German Society of Neurology!

What else can you do to make the tremor better?

If neither propranolol nor primidone nor a combination of both is sufficiently effective, the next step is to try to treat with gabapentin or topiramate. Both drugs are originally also used in the treatment of epilepsy, but are also used for other diseases and symptoms, for example, gabapentin for neuropathic pain. Only if the desired effect is not achieved can the use of a deep brain stimulator be considered.

If this cannot be used due to contraindications or if the patient refuses the operation, there are still highly effective reserve drugs available, which your neurologist can inform you about if necessary. These include the neuroleptic clozapine or the sedative phenobarbital. Especially when the essential tremor affects the head or voice, drugs and deep brain stimulation are often less effective.

If there is controversy about whether the use of botolinum toxin (“Botox”) is suitable for therapy, it is best to consult your treating neurologist. Since essential tremor is often aggravated by emotional strain and stress, it should be avoided if possible. Relaxation methods such as progressive muscle relaxation or autogenic training can also help here. Although essential tremor often improves after alcohol consumption, due to the side effects of alcohol such as addiction, organ damage, etc., it is of course not advisable to consume alcohol regularly!