Essential tremor - Treatments

Propranolol

Propranolol is a beta blocker. These are drugs that slow down your heartbeat. They're usually used to treat high blood pressure or angina (chest pain). They may also help control essential tremor.

Brand names for propranolol include:

• Angilol
• Inderal
• Half-Inderal LA
• Inderal-LA.

There's been lots of research to show that propranolol is likely to help if you have essential tremor.[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] We found 11 small good-quality studies (called randomised controlled trials), all of which found that taking propranolol helped control shaking.

One study also found that taking propranolol for a year worked about as well as taking another blood pressure drug (called clonidine).[12] But there haven't been any other studies lasting longer than six weeks. So we don't know whether propranolol works for longer or whether the effect wears off.

There hasn't been enough research to know for certain how other beta blockers compare with propranolol for treating essential tremor. Three small studies found that sotalol (brand names Beta-Cardone and Sotacor) and atenolol (Atenix, Tenormin) seemed to help.[6] [10] [13] One study found that pindolol (brand name Visken) made essential tremor worse.[9]

Beta blockers can have side effects. In studies, about 1 in 10 people stopped taking propranolol because they felt tired or got a slow heart rate.[3] Other side effects are depression, dizziness and sexual problems.

If you have asthma, heart problems or diabetes, you need to tell your doctor. You may not be able to take these drugs.

Primidone

Primidone is a drug that doctors usually use to treat epilepsy, but they also prescribe it for essential tremor. Its brand name is Mysoline.

Three small studies that compared people who took primidone with people who took a dummy treatment (a placebo). People who took primidone felt they had less tremor.[14] [15] [16] Primidone also helped people in their daily activities, such as writing and eating.

But primidone has side effects. In one study, a quarter of the people had to stop taking primidone. You may get a bad reaction to the first dose you take. You could get nausea or dizziness, or feel confused. Other side effects include being tired and feeling depressed.[15] Primidone may also cause memory problems. You're more likely to get side effects if you're very old or very young.

Topiramate

Topiramate is another drug that's usually used to treat epilepsy. Its brand name is Topamax. In three studies of people with essential tremor, the people got less tremor after taking topiramate.

But topiramate also caused side effects. In one study, about a third of people taking topiramate dropped out of the study because they had side effects such as loss of appetite, confusion, difficulty concentrating, nausea, weight loss, and numbness and tingling.[17] [18]

Phenobarbital

Phenobarbital is another medicine that's usually used to treat epilepsy. Three small studies looked at whether it can help with essential tremor.[7] [14] [15]

One study found that phenobarbital reduced tremor when it was measured by a machine. But it didn't help people write better or feel that they had less tremor.[15]

Phenobarbital can cause tiredness, depression and memory problems, especially if you're very young or very old.

Botulinum A

Botulinum toxin type A (brand names Botox and Dysport) is produced by certain bacteria. It works by blocking signals from your nerves. Doctors can inject tiny amounts of this toxin into a muscle to relax it. It can be injected into the muscles of the forearm (for a hand tremor) or into the muscles of the neck (for a head tremor).

Two studies of people who had hand tremor found that getting an injection of botulinum A into the forearm helped. The people got less tremor and the effect lasted from one to three months.[19] [20] But the injections didn't always help people with their activities, like eating.

The main side effect of botulinum A injection is hand weakness. Very rarely botulinum toxin may spread from the place it has been injected. If you get any problems with swallowing, talking or breathing after one of these injections, get medical help straight away.[21]

We need more research to say for certain whether this treatment can help.

Benzodiazepines

Benzodiazepines are a kind of sedative. Examples of benzodiazepines are lorazepam (brand name Ativan), alprazolam (Xanax), and clonazepam (Rivotril).

There have been a few small studies of using benzodiazepines for essential tremor.[16] [22] [23] One study found that people who took alprazolam for about a month could write and feed themselves better.[16] But we don't know for certain whether benzodiazepines work for essential tremor. That's because the studies were small and short.

If you're very bothered by tremor and other medicines haven't worked for you, your doctor may prescribe a benzodiazepine. But they can cause sleepiness and you can get addicted to them, so your doctor needs to supervise their use.

Gabapentin

Gabapentin (brand name Neurontin) is usually used to treat epilepsy.

Three small studies compared gabapentin with a dummy treatment (a placebo).[8] [24] [25] But we're not sure whether it works. The studies were very small and their results differed. People in the studies got side effects that included tiredness, drowsiness, nausea and dizziness.

Calcium channel blockers

Calcium channel blockers are usually used for high blood pressure and angina (chest pain). Examples are nifedipine (brand names Adalat and Coracten SR), nicardipine (Cardene), and nimodipine (Nimotop). There have been two studies that used calcium channel blockers for essential tremor. But we still don't know whether these drugs help.[26] [27] That's because the studies were small and weren't of good quality.

Calcium channel blockers can cause dizziness, flushing, swelling in the legs and an upset stomach.

Clonidine

Clonidine (brand name Catapres) is a drug that's usually used for high blood pressure.

One study found that taking clonidine for a year worked about as well as taking propranolol (a beta blocker).[12] Another study compared clonidine with a dummy treatment (a placebo). But the study was too small to draw any conclusions.[28] Clonidine can cause sleepiness and a dry mouth.