Question: I am 72 years old and have had essential tremor (diagnosed by a neurologist) for about 15 years. I’m getting worse, and I’ve found nothing on the Internet to help my symptoms. Recently, a neurologist prescribed primidone and it sent me for a loop! Is there any holistic or mild medication I could take?
Dr. Hibberd's Answer:
Essential tremor (ET) is common, has a genetic base, is usually progressive, and lately has been proposed to be a common symptom of a variety of degenerative diseases as opposed to a single disorder. There is no cure, but there are medications that are used to decrease tremor with variable degrees of success.
ET is tremor noted during voluntary motion (not present at rest) that can occur in any area of the body, but is most common in the arms and hands. Although it may be seen at any age, it is most common in patients over the age of 60.
It is a progressive disease, and onset after the age of 65 is associated with an increased risk of developing dementia. The tremor often begins in the arms and may progress to involve other areas most often the head, neck, jaw, tongue, or voice, but rarely the legs. Head tremor is more common in women.
A low-dose beta blocker such as Inderal (propranolol) often helps blunt this condition. You are wise to avoid stimulants and caffeine. Fatigue, physical and mental stress, low blood sugar and cold stress will accentuate symptoms. Avoid first generation antidepressants (tricyclics) and lithium.
Some patients may find sufficient relief with an occasional alcoholic drink while others require low dose anticonvulsant therapy, most often Primidone (mysoline) and Neurontin (gabapentin). Also, patients with ET have an approximately four-fold increase in risk of developing Parkinson's disease, so be aware of this when evaluating treatment choices.
As you have experienced, we need to be aware of the risk-benefit ratios of the medicines we offer for this condition. While most patients are able to compensate without medications, others with superficially mild tremor can be disabled in varying degrees. We also need to be aware of other conditions such as hyperthyroidism and Parkinson's disease that use entirely different medications and whose presence may be mistaken for ET or, indeed, to co-exist.
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