Essential tremor

Posted On May 14, 2020

Essential tremor (ET) is the most common cause of tremor.

• Symptoms and signs
  • persistent bilateral postural tremor > 5 years
  • Action tremor: bilateral, may be asymmetrical
    • postural, kinetic, intention
  • May have head tremor
  • No other abnormal neuro sign
  • except Froment’s sign:
    • cogwheel without rigidity
  • Exacerbated by anxiety, excitement or adrenergic stimulation
  • Not exacerbated by caffeine
• Essential tremor (ET) and Parkinson disease (PD)
  • Prevalence over 65 years old: ET 4.6%, PD 1.8%
  • Pathology (post mortem): ET cerebellum, PD substantia nigra
  • having ET or PD, may increase risk of having another
  • ET onset before 40 years old, positive family history is 80%

Treatment

• Intermittent treatment
  • propranolol
  • low dose short acting benzo, such as alprazolam
• Continuous therapy
  • Propranolol (60-320 mg/day), may use LA form
  • primidone (up to 750 mg/day)
  • may use in combination
  • Other medications
    • gabapentin
    • topiramate (target dose 400 mg/day)
    • nimodipine. (30 mg qid)
  • pregabaline, levetiracetam no benefit.