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Practice Parameter: Therapies for Essential Tremor
Neurology (2005)
  • Kelly L. Sullivan, University of South Florida
  • Theresa A. Zesiewicz, University of South Florida
  • R. J. Elble, Southern Illinois University School of Medicine
  • Elan D. Louis, Columbia University
  • Gary S. Gronseth, University of Kansas
  • W. G. Ondo, Baylor College of Medicine
  • R. B. Dewey, Jr., University of Texas Southwestern Medical Center at Dallas
  • W. J. Weiner, University of Maryland School of Medicine
Background: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use.

Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence.

Results and Conclusions: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.
  • Practice parameter,
  • Therapies,
  • Essential tremor
Publication Date
June 22, 2005
Citation Information
Kelly L. Sullivan, Theresa A. Zesiewicz, R. J. Elble, Elan D. Louis, et al.. "Practice Parameter: Therapies for Essential Tremor" Neurology Vol. 64 Iss. 12 (2005) p. 2008 - 2020 ISSN: 1526-632X
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