High blood pressure pills and seizure medications may help people with uncontrollable shakes caused by essential tremor.
New treatment guidelines released today show that commonly used drugs, and in some cases surgery, can provide significant relief from the symptoms caused by essential tremors. Often the condition can interfere with activities of daily living, and treatments may help these people live more normal lives.
Essential tremor is a neurological disorder that becomes more common with increasing age and affects up to 5 percent of adults. The condition causes uncontrollable shaking of the hands, head, legs, voice, or other parts of the body.
Although essential tremor is not considered life-threatening, the tremors can cause difficulty dressing, eating, and speaking.
"Though the tremors do not completely disappear with treatment, they can be managed, making a huge difference in the daily lives of people with essential tremor," says researcher Theresa Zesiewicz, MD, associate professor of neurology at the University of South Florida in Tampa, in a news release.
Drugs Recommended for Essential Tremor
The new guidelines, which appear in the June 28 issue of Neurology, outline recommended treatments for essential tremor based on a review of 211 studies on the subject.
Researchers say the results show that medications can significantly reduce tremors, although they did not completely eliminate them in most cases.
Recommended medications for essential tremor include:
Propranolol,a drug used to treat high blood pressure, was most highly recommended for tremors affecting the arms and legs and, to a lesser extent, the head. Primidone, an antiseizure drug, for limb tremors. Sotalol or atenolol, drugs used to treat high blood pressure, can be used as alternatives to propranolol and primidone for limb tremors. Gabapentin and topiramate, antiseizure drugs, were also recommended for limb tumors.
Researchers say there is also modest evidence to recommend injections of Botulinum toxin (Botox) for limb, head, or voice tremors.
"Side effects can accompany each of these medications," says Zesiewicz. "If side effects become too adverse, doctors and patients can discuss other drug options."
Surgery Also an Option
For tremors affecting the arms or legs that do not respond to drug treatment, researchers say surgery may also be recommended.
In those cases, deep brain stimulation, in which electric probes are placed in the brain to block the impulses that cause tremors, was found to have fewer severe complications than the other surgical alternative that was reviewed, thalamotomy. Thalamotomy involves cutting a small part of the brain involved in movement control (the thalamus) to stop the signals that cause tremors.
"The surgical option depends on each patient's circumstances and the risk for complications during and after the procedure," says Zesiewicz.
But researchers say there isn't enough evidence to recommend deep brain stimulation to treat head or voice tremors.
Other Ways to Cope
Because living with essential tremor can interfere with normal living and social interactions, simple lifestyle changes may help. Here are a few things that to consider:
If you have a social event planned, you may want to consider postponing certain prescription drugs that can aggravate tremor, such as thyroid or asthma medications. Be sure you check with your doctor first. Avoid foods that contain caffeine, such as sodas, coffee, and tea. Place a napkin between a cup and saucer to avoid rattling. Avoid awkward or uncomfortable positions. Use auto dial on a cell phone or have the operator place the call.
SOURCES: Zesiewicz, T. Neurology, June 28, 2005; vol 64: pp 2008-2020. News release, American Academy of Neurology. WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Essential Tremor."