Question: What can be done to slow (or erase) essential tremor?
Dr. Hibberd's Answer:
Essential tremor is a benign tremor whose specific cause is unknown. It usually affects the hands but rarely the legs or feet, and it occurs without loss of co-ordination or mental function.
Essential tremor may be familial (usually a dominant trait) and may be seen at any age, but is most common in those over the age of 65. It may be associated with underlying disorders and is easily exacerbated by stress, dietary supplements, additives, and some medications.
Sometimes this tremor may be mimicked by underlying conditions such as alcohol withdrawal, cigarette smoking, Wilson's disease, pheochromocytoma, hyperthyroidism, and Parkinson's disease. So a baseline history, physical examination, EKG, and baseline labs to include thyroid function are usually advised.
Caffeine, stimulants, and decongestants will often worsen this tremor, while some prescription drugs may offer variable relief that seems to differ by individual. Low-dose beta blockers are often useful with effective doses of Inderal as low as 10 mg two to four times a day.
Once the dose of maximum effectiveness has been reached, consider conversion to a once-daily, long-acting preparation under supervision from your primary care physician. Be sure an EKG is done first to be sure you have no heart blocks that may be worsened by using this medication.
Other medications such as primadone, Topamax, or gabapentin (anticonvulsants), are available, as are mild tranquilizers such as Xanax or clonopin, and selected calcium-channel blood pressure drugs may be beneficial.
Resistant cases may be amenable to localized Botox injections and stimulation devices. If control becomes a challenge, consider a neurology consultation early-on rather than waiting for problems.
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