Treatment of
Essential Tremor
What is the best treatment for essential tremor?
The best treatment for Essential Tremor does not exist.
The treatment of Essential Tremor must take into account the person's gender, age, pre-existing diseases, weight, among other factors.
Of course, there are some medications that work for most people. But it's important to be clear, that you may not be like most people, and that's okay!
Some drugs are generally more helpful than others, but treatment must be targeted to take several factors into account. When the tremor is mild, almost always, just one medication is enough. But when the tremor gets worse, and it can happen over a lifetime, a combination of medications or even surgery may be needed.
Explaining the drugs used for Essential Tremor
Medicines are classified according to their class. That is to say, about the mechanism of action of the remedy. A remedy can be used for more than one purpose. So, that medicine that is written: "medicine for high blood pressure", can be used for more other things (even if you don't have high blood pressure). And don't worry, your pressure won't go down! (if you've been following the doctor's directions properly!)
Know the main remedies for Essential Tremor
One of the most effective drug classes in the treatment of essential tremor are thebeta blockers(so called because of the mechanism of action).
São beta blockers most common and used:
propranolol
Atenolol
Metoprolol
carvedilol
(among many others - they usually end with "ol").
Good side: They are very effective, and almost always do not lead to any side effects! It can be started at low doses like 20mg per day (from propranolol). And increased up to 320mg if necessary!
Most of the time, doses of 80-160mg are the most useful (and have great tolerability, with almost no side effects).
Bad side: It is contraindicated for those with asthma, or some arrhythmias, such as bundle branch blocks.
They can lower the heart rate, which is not always a problem, but important to watch out for in the elderly, or in those who already use several medications. In larger doses, there may be an action to lower blood pressure (but this is a medicine that lowers blood pressure a little, even in high doses!).
Youanticonvulsantsare also very useful in the treatment of Essential Tremor
Examples of anticonvulsants used in the treatment of Essential Tremor are:
Primidone
phenobarbital
Gabapentin
Pregabalin
Topiramate
Good side: They are effective, and there are several that can be used together, or together with beta-blockers.
Bad side:Depending on the medicine, they may have more side effects, such as hair loss, drowsiness. But it depends a lot on the medicine and the dose used!
Surgery for Essential Tremor
The most used surgery is the implantation of a pacemaker, called DBS (Deep Brain Stimulation). This is the same surgery as for Parkinson's disease, but it places the pacemaker elsewhere in the brain. There are other types of surgery as well such as ablative surgeries.
Surgery is indicated for cases refractory to drug treatment, in which the tremor is highly limiting or disabling. It's not a cure. But the response is very good for most people, when properly indicated.