Drug Treatments for Essential Tremor

When essential tremor (ET) significantly interferes with daily activities, long-term drug treatment is needed. Drugs most commonly used to treat essential tremor include beta-blockers (propranolol) and an epilepsy drug called Mysoline (primidone). Topamax (topiramate), another drug used to treat epilepsy and migraine help some people.

With the use of medication, people with essential tremor may see improvement in their ability to control their tremor and improvement in activities such as drinking from a cup or using food utensils. More specialized motor functions, such as being able to thread a needle, may still be too difficult. However, for most people, essential tremor is not disabling.

Recommended Related to Epilepsy

What to Do if Your Child Has an Epileptic Seizure

Most epileptic seizures are over so quickly that you don't really have much time to do anything. After it's over, you simply make sure that the child wasn't injured. Tonic-clonic seizures are the most dramatic and frightening of the seizures, and they usually last longer than other seizures. Here are some suggestions for handling them: Move things out of the way so the child won't injure him or herself. Loosen any tight clothing around the neck

Most epileptic seizures are over so quickly that you don't really have much time to do anything. After it's over, you simply make sure that the child wasn't injured.

Tonic-clonic seizures are the most dramatic and frightening of the seizures, and they usually last longer than other seizures. Here are some suggestions for handling them:

• Move things out of the way so the child won't injure him or herself.
• Loosen any tight clothing around the neck.
• Put a pillow or something soft under the head.
• Lay him or her on one side.
• Time the seizure.

Call an ambulance about a seizure if:

• The child was injured during the seizure
• The child may have inhaled water
• The seizure lasted longer than five minutes
• There is no known history of seizures

Things not to do during a seizure:

• Don't put anything in the mouth. First of all, despite what you've heard, it's impossible to swallow your tongue and choke. While the child may bite his or her tongue during a seizure, trying to cram something in the mouth probably won't work to prevent this. You may also get bitten, or you may break some of the child's teeth.
• Don't try to hold the child down. People, even children, have remarkable muscular strength during seizures. Trying to pin a child with a seizure to the ground isn't easy and it won't do any good, anyway.
• Don't give mouth-to-mouth resuscitation until the seizure is over. After the seizure has ended, give mouth-to-mouth resuscitation if the person is not breathing.
• Don't call an ambulance during a typical seizure. For a lot of people, the first response to seeing a seizure is to call 911. But for the vast majority of seizures, that isn't necessary. It's also frightening for a child to spend an afternoon in the hospital unnecessarily. Instead, only call for medical help if the child is injured during the seizure, if a seizure lasts more than five minutes, or if it seems like one seizure is immediately following the previous one.

Your health care provider will determine, which treatment is best for you based on your medical history. The goal of treatment is to provide maximum improvement in function while minimizing the side effects of the medication you are taking.

For people with mild essential tremor, drug therapy is usually not necessary. Tremors may be lessened by minimizing exposure to emotional stress and avoiding substances, such as caffeine and nicotine, which may increase tremor. In social situations, a person with mild tremor can take a beta-blocker or drink a small amount of alcohol, if such treatments are approved by a doctor. Although alcohol may lessen the tremor, there is the danger of slowly increasing your intake and this must be done infrequently.

Beta-Blockers for Essential Tremor

The beta-blocker Inderal (propranolol) has been used to treat essential tremor for more than 40 years. Other beta-blockers such as Lopressor also may be effective.

It is not clear how Inderal reduces tremors, but the drug may work by blocking nerve impulses to the muscles. Approximately 50% to 60% of people taking Inderal experience some improvement in function, but total tremor suppression usually is not achieved. The greatest improvement is in hand and voice tremors. The drugs may be taken once a day (for longer-acting formulation) or twice a day depending upon the formulation used.

Side Effects of Beta-Blockers

Beta-blockers are not right for everyone with essential tremor. Side effects of beta-blockers may include:

• Slowing heart rate
• Drop in blood pressure
• Fainting
• Apathy
• Fatigue
• Erectile dysfunction
• Depression

Some of these side effects may require that the treatment be stopped.

Be sure to tell your doctor if you:

• Have asthma or other bronchial conditions (beta-blockers may cause or worsen asthma symptoms)
• Have coronary artery disease or certain heart arrhythmias
• Have kidney disease
• Have liver disease
• Have diabetes
• Are pregnant or nursing

While you are taking Inderal, your health care provider will monitor your heart rate and blood pressure regularly. In general, Inderal works over a long period of time to suppress tremors; however, nearly 10% of people will develop tolerance to the drug after a year. This means that the drug stops being effective when given in the same dose as when you began treatment. In this case your doctor will suggest another medication or treatment.

Botox (subtype A) and Myobloc (subtype B) are the brand names for botulinum toxin, which can be used to treat some movement problems. The drugs work by weakening  muscles to reduce tremor.  The drug also can be used to treat voice or head tremors. This treatment involves an injection once every three months.

Do not take this drug if you are pregnant or if you have myasthenia gravis, post-polio syndrome, or Eaton-Lambert syndrome. Side effects of Botox are rare but may include excessive muscle weakness or loss of appetite.

Are There Alternative Therapies for Essential Tremor?

Currently, there is no evidence that alternative treatments are beneficial in treating essential tremor. Patients who have tremors that worsen with emotional stress may find relaxation therapies helpful at temporarily easing symptoms.

Some herbal supplements may make tremor worse. Always consult your doctor before trying any alternative therapy.