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Treatment of essential tremor: current status
  1. Soumya Sharma1,2,
  2. Sanjay Pandey1
  1. 1 Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
  2. 2 Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
  1. Correspondence to Dr Sanjay Pandey, Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India; sanjaysgpgi2002{at}yahoo.co.in

Abstract

Essential tremor is the most common cause of tremor involving upper limbs, head and voice. The first line of treatment for limb tremor is pharmacotherapy with propranolol or primidone. However, these two drugs reduce the tremor severity by only half. In medication refractory and functionally disabling tremor, alternative forms of therapy need to be considered. Botulinum toxin injections are likely efficacious for limb, voice and head tremor but are associated with side effects. Surgical interventions include deep brain stimulation; magnetic resonance-guided focused ultrasound and thalamotomy for unilateral and deep brain stimulation for bilateral procedures. Recent consensus classification for essential tremor has included a new subgroup, ‘Essential tremor plus’, who have associated subtle neurological ‘soft signs’, such as dystonic posturing of limbs and may require a different treatment approach. In this review, we have addressed the current management of essential tremor with regard to different anatomical locations of tremor as well as different modalities of treatment.

  • essential tremor
  • beta- blockers
  • botulinum toxin
  • focused ultrasound
  • thalamotomy, deep brain stimulation
  • treatment of essential tremor: current status
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Footnotes

  • Contributors SS and SP contributed in manuscript preparation by writing the first draft, review and critique and are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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